The overwhelming majority of Americans falling into the Medicaid coverage gap are in the South. Due to the obstruction of politicians like those running the show in North Carolina, millions of people who could be insured at federal government expense must instead do without. The scandalous result: thousands of preventable deaths each year.

As Alex Zielinski at Think Progress explains, however, there are some new and encouraging signs that cracks in the obstructionist wall are starting to show:

Red States Begin To See The Light On Medicaid Expansion

Conservative leaders may be warming up to Obamacare’s optional Medicaid expansion — a program that has been traditionally gridlocked in GOP-led states — in an emerging trend that could have a serious influence on the program’s adoption in fellow red states. Recent state elections unveiled a majority of these changes.

At first, many voters in favor of Medicaid expansion feared the recent elections would worsen their chances. And with a new, staunchly anti-expansion governor elected in Kentucky and a unwavering Republican majority in the Virginia Senate, it’s clear why. But these potential road blocks to further state expansions may be countered with other unexpected victories in other states.

The biggest surprise came out of the Louisiana election, where Democrat John Bel Edwards won the governor’s race by a landslide this weekend. He’ll fill the seat of current Governor Bobby Jindal, who has rejected the “subpar” Medicaid expansion program from its start. Edwards is a true Southern Democrat — he’s openly against abortion and gun control — but stands firmly behind progressive health care and labor plans. He’s already pledged to sign an executive order authorizing Medicaid expansion on his first day in office. This would provide immediate coverage to an additional 225,000 uninsured residents.

Meanwhile, in Kentucky, Governor-elect Matt Bevin may be softening his opposition to this Obamacare provision. During his campaign, Bevin spoke firmly about his opposition to Medicaid expansion — which already exists in the conservative state. But now that the election’s over, he’s mentioned a scaled-back attack on the expansion program. Instead of cutting off the 400,000 people who benefit from the state’s Medicaid expansion, he may work with the feds to just adapt it to his liking. This will likely still shed some benefits of the current state program, but won’t affect its users as harshly as predicted.

Kentucky’s expected action — or inaction — may have inspired an unprecedented move toward expansion in a fellow red state, where no Democrat holds a political office: Alabama. Read More


Retiree-benefotsLegislative staff pitched a policy solution to lawmakers on Monday that could reduce the state’s $25.5 billion unfunded liability associated with the Retiree Health Benefit Fund by 11.8 percent, producing a larger cost savings than the Senate’s proposal to eliminate retiree health benefits for all teachers and state employees hired after January 1, 2016.

The fix? Shift some of the costs associated with providing fully funded retiree health plans to the federal government. Going that route would require all retirees to enroll in Medicare Advantage plans—and by doing so, retirees shouldn’t be expected to bear more out-of-pocket expenses and the state would save $64 million annually, reducing the total unfunded liability by about $3 billion.

The Senate, on the other hand, wants to address the unfunded liability by eliminating retiree health benefits for new hires beginning in 2016. Some say this option will unfairly shift more costs to the worker and could hurt recruitment efforts, while producing an estimated smaller cost savings of 10 percent as opposed to the 11.8 percent that would come with enrolling retirees into Medicare Advantage plans.

For the full story, head on over to our main site. And you can read the legislative report below.


A few short lines in the 2015-17 Senate budget would eliminate state-paid health retirement benefits for teachers and state employees hired after January 1, 2016.

“This will negatively impact the state’s ability to recruit good, qualified folks,” said Richard Rogers, executive director of the North Carolina Retired Governmental Employees’ Association. “In the future, I don’t see folks sticking with state government for the long term or for a career.

Current law provides teachers and state employees with a paid health insurance plan for the duration of retirement. It’s a graduated system, said Rogers, so employees must work a certain number of years in order to receive the maximum benefit of a fully-paid health insurance plan.

The Senate budget provision, located deep in the biennial proposal that was released and passed by Senators this week, would affect teachers and state employees who join the workforce after January 1, 2016 by eliminating the health insurance benefit altogether.


The provision also affects those who stop out of the workforce and withdraw their retirement benefits from the state system, then re-join the workforce after January 1, 2016. Those state employees would also forfeit their retiree health insurance benefits.

The retiree state health plan provides health care coverage to more than 685,000 teachers, state employees, retirees, current and former lawmakers, state university and community college personnel, state hospital staff and their dependents, according to the plan’s website.

The General Assembly is expected to spend the rest of the summer hammering out a final 2015-17 budget for the state. Stay tuned to see if the Senate’s proposal to axe retirement health benefits for teachers and state employees makes it past the cutting room floor.


We have written before about King v. Burwell, the case that will be heard before the US Supreme Court to determine whether or not health insurance subsidies can flow to states that refused to establish state-based marketplaces under the Affordable Care Act. As John Stewart has noted, justices would have to be more literal than Amelia Bedelia to find for the plaintiffs, but we live in strange times where anything seems possible.

The next question then is if the Supreme Court strikes down subsidies how many people would it impact? Now Kaiser Family Foundation has a helpful interactive map to estimate an answer. KFF researchers think more than 13 million people nationally, and about 1 million people in North Carolina, would lose tax credits if the Supreme Court denies subsidies to federal marketplace states. For most of these folks insurance would immediately become unaffordable. This is especially true because prices would most likely spiral upward as younger, healthier enrollees lose coverage.

That is a stunning figure. It would be like the Supreme Court cutting the number of North Carolinians receiving Medicare in half.

The cruel truth is that Congress could easily fix this problem by adding a few words to the Affordable Care Act, but they are so obsessed with repealing the legislation that they are unlikely to repair it. The state legislature could also provide a patch by at least establishing a governance structure for a state-based marketplace, but they are also unlikely to move. After all, the federal government stands ready to pay the state to expand insurance to 500,000 more state residents and that hasn’t gained any legislative traction.

So, we wait, while medical care for 1 million North Carolinians hangs in the balance.


healthcare.govIf you don’t have affordable health insurance through an employer then now is your chance to shop for a plan on the individual market. New options are now available and many people can get help paying premiums. In fact, in 2014 more than 90 percent of people who enrolled in an insurance plan through in North Carolina received financial assistance, and of this group the average premium was $80 per month. This is for a comprehensive policy.

The current open enrollment period  stretches until February 15, 2015, but if you want your benefits to start on January 1 then today is the day to purchase a plan. This is true no matter when you bought insurance in 2014.

The website is working smoothly these days but you don’t have to navigate the process by yourself. Plenty of health insurance agents are ready to assist you. Also, application counselors and navigators based at nonprofits around the state can help. They are all volunteers or grant funded and have no financial incentives to steer you toward any particular company or plan. You can check out this website to find help in your area. You can also call 1-855-733-3711.

It is especially important to shop around even if you bought a policy. If you don’t actively switch plans then you will be automatically reenrolled. But with new options and more companies competing in the state reenrollment is unlikely to get you the best deal. As with most products, you need to shop around.

Another reason to buy a policy today is that you aren’t stuck with the plan you choose. To prevent a gap in coverage you can purchase a policy now and continue investigating your options during open enrollment. As long as you act before February 15 then you can opt for a different plan. Last year once you chose a policy you were stuck. This year you can change plans during the entire open enrollment period.

Unfortunately, many people trying to obtain coverage will discover that they fall into the Medicaid gap in North Carolina. Because the state legislature has refused to expand Medicaid working families earning less than 100 percent of federal poverty level may still find coverage unaffordable, and they won’t get help paying premiums. If our lawmakers choose to act in the next legislative session then most struggling citizens will be able to obtain comprehensive insurance.