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Funeral

Photo: NC NAACP

As the North Carolina NAACP holds a “Denial of Medicaid Funeral Procession” today, it’s worth considering some of the facts and data surrounding the impact of North Carolina’s ongoing refusal to expand Medicaid under the Affordable Care Act:

The North Carolina Institute of Medicine’s 2009 Access to Care study begins with this statement: “The lack of health insurance coverage is the foremost barrier to accessing health care services.”

In the report’s introduction it continues:

In a statewide survey of adults, nearly half of the uninsured in North Carolina reported forgoing necessary care due to cost, compared to 10% of individuals with insurance coverage. Lack of coverage also adversely affects health as the uninsured are less likely to get preventive screenings or ongoing care for chronic conditions. Consequently, the uninsured have a greater likelihood than people with coverage of being diagnosed with severe health conditions (such as late stage cancer), being hospitalized for preventable health problems, or dying prematurely. In fact, adults who lack insurance coverage are 25% more likely to die prematurely than adults with insurance coverage.

A Families USA report in 2010 estimated that before the Affordable Care Act passed nearly 1,000 North Carolinians died each year between 2005 and 2010 due to lack of health insurance.

What has changed is that the states now have an unprecedented tool for saving lives. North Carolina now has the opportunity to extend health insurance coverage to nearly all low-income adults, the majority of whom are working. The federal government will finance nearly the entire cost of this coverage expansion. Not expanding coverage is not only morally misguided but it is also fiscally irresponsible. Read More

Commentary

Health-Reform-SBIn case you missed it, be sure to check out Sahil Kapur’s article today on Talking Points Memo about the fast-fading attacks on Obamacare and why a political “nightmare” may be coming to pass for the American right. One of Kapur’s key sources: none other than long-time conservative icon William Kristol, who two decades ago led the charge to defeat Bill Clinton’s proposed healthcare overhaul. Back then, Kristol’s chief fear was of what would happen was, effectively, the same thing that is happening now: the establishment of a new law that would fast become an integral part of the middle class safety net and, as such, quickly become politically unassailable.

As the TPM story notes: the massive healthcare industry is adapting, premiums are stabilizing and even Mitch McConnell wants the hundreds of thousands of newly-insured Kentuckians to keep their Obamacare.  In short, Kristol’s fear that “reform would paint Democrats as ‘the generous protector of middle-class interests’ and strike a ‘punishing blow’ to the GOP’s anti-government ideology” appears, by an increasing number of indications, to be coming true.

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Winston Churchill famously stated that “Democracy is the worst form of government, except for all the others.” One is increasingly tempted to offer the same assessment of Obamacare.

Is it flawed and messy? Absolutely. Could we call envision a scenario in which each of us — acting as philosopher kings — could craft a better system? Sure.

But when it gets down to the nitty-gritty of making something work in a huge, complex and wildly diverse nation, the following AP story tells you what you need to know about Obamacare on July 24, 2014:

A new study estimates that more than 10 million adults gained health insurance by midyear as the coverage expansion under President Barack Obama’s law took hold in much of the country.

The study published Wednesday in the New England Journal of Medicine found that the share of Americans ages 18 to 64 without insurance dropped by a little more than 5 percentage points.

States that embraced the law’s Medicaid expansion saw significant coverage gains among low-income uninsured people. About half the states have expanded.

The law offers subsidized private insurance for middle-class people who don’t have access through their jobs and expanded Medicaid for low-income adults.

The latest study results are in line with findings by Gallup and with estimates from the Congressional Budget Office.

Read the AP article by clicking here.

 

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Health-Reform-SBAs Adam Linker explained last week when he debunked the latest conservative mythology surrounding the Affordable Care Act, the law continues to succeed despite its imperfections and the endless, hysterical attacks of the President’s political opponents.

Today, there’s still more confirmation of this undeniable reality from Washington state. As The Olympian reported this morning, the state’s uninsured rate has been plummeting:

State insurance officials say fewer than 9 percent of Washington residents still don’t have health insurance.

That’s a significant improvement from numbers before the Affordable Care Act went into effect.

The state Office of the Insurance Commissioner counted 970,000 uninsured Washington residents last year. That number is now 600,000 or about 8.65 percent of the state population.

Agency spokeswoman Stephanie Marquis told The Olympian (http://is.gd/p2XsBG ) two factors are driving the improvement: enrollment in Medicaid and sign-ups for private insurance, but inside and outside of the new state health insurance exchange.

The insurance department reports the individual market has grown to more than 327,000 policies. That represents about 81,000 more insured people than before Oct. 1, when Washington’s Health Benefit Exchange opened.

The exchange also helped sign up nearly 350,000 people for free insurance through Medicaid.

Despite the many successes here, at last check, North Carolina’s uninsured rate remains significantly higher.

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Last October Gov. McCrory caused a stir, and raised some eyebrows, when he said that the state may be forced to expand Medicaid due to a “new” regulation.

The policy to which he was referring is called presumptive eligibility. Presumptive eligibility allows states to give permission to hospitals and other providers to temporarily enroll certain people in Medicaid. North Carolina, for example, allows presumptive eligibility for pregnant women. That means if a hospital does an initial check and it looks like a pregnant woman is likely to qualify for Medicaid then the hospital can temporarily enroll her and get paid for the services it provides. Meanwhile, an application for full Medicaid can be processed without a disruption in care.

This policy is critical for ensuring that patients get care and providers get paid.

In states with efficient systems that can process Medicaid eligibility in real time, this temporary measure is not as important. In states where parents are having to ration medicine for their children due to a backlog in processing Medicaid applications, presumptive eligibility is a critical tool.

Health reform gave hospitals more latitude to presumptively enroll patients, even if the state has not granted the hospital permission to participate in the program. Other providers, notably Community Health Centers, however, are still not able to use presumptive eligibility to enroll children in Medicaid. The Community Health Centers are still limited to enrolling pregnant women.

Ultimately, the state needs to fix its computer system. In the meantime, we need to get care to children. We could start by granting Community Health Centers, and possibly other providers, the ability to temporarily enroll likely eligible kids in Medicaid while DHHS clears its application bottle neck.

And until the state expands Medicaid to all low-income people we will need every splint and bandage we can find to patch our broken system.