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DocwfoldedarmsOn Monday of this week, the North Carolina House Committee on Health met to hear from advocates for and against House Bill 200, also known as an amendment to North Carolina’s Certificate of Need (CON) law. While both advocates had strong arguments, there was something that Connie Wilson, a lobbyist representing the North Carolina Orthopedic Association and groups of ophthalmologists, said that didn’t seem quite right.

The most common argument that supporters of repealing or amending North Carolina’s CON law make is that costs associated with health services will decrease as a result of increased competition between hospitals and outpatient medical facilities. To use Ms. Wilson’s words, people are no longer “forced to go into higher cost facilities.” Unfortunately, supporters of CON law amendments and repeal do not present the other side, and that is how some North Carolinians could be “forced” out of the health care safety net.

The state of Georgia was presented to the House Health Committee as an example of how amending CON laws can lead to positive health care outcomes. In 2008, Georgia amended its CON law so that joint-venture or single-specialty ambulatory surgery centers (ASCs) are exempt from CON laws. However, Georgia’s amendment to the CON law was not a magic bullet as Georgia still experiences yearly increases in health care expenditures like other states with CON laws.

More importantly, supporters of amending CON laws did not present data on how the amendment impacted rural hospitals in Georgia. For example, Telfair Regional Hospital closed in 2008 — the same year ASCs became exempt from CON laws in Georgia. Since that first closing, five additional rural hospitals in Georgia experienced closures. This leaves many people without primary and emergency health care.

North Carolina has already experienced two rural hospital closures since 2010 and risking additional closures will leave many residents without a medical home. Even though, HB 200 contains a provision allowing rural hospitals to approve ASCs – the bill considers a hospital as “rural” if it is located in a county with fewer than 100,000 residents – it does not take into account surrounding counties that depend on that one hospital for health care. What’s more, HB 200 also includes a provision requiring that at least seven percent of health services should be charity care. Considering that 20 percent of rural residents are uninsured and nearly one-quarter of rural residents live at or below the federal poverty line, seven percent charity care does not seem adequate. If rural hospitals become even more strained and the legislature does not expand Medicaid, where will rural residents receive care? As stated in previous posts, CON laws help ensure that all North Carolinians have access to health care and that hospitals and health services facilities don’t just provide services in wealthier counties.

Commentary

People fear the unfamiliar. It’s human nature. When a new threat emerges, our minds often race about it — even when the same old threats are far more worrisome.

This is one reason a healthy (heh) number of my friends are anxious about the Ebola virus. Maybe yours are, too. Heck, maybe you are. Well, here’s the good news: while certainly a frightening disease, Ebola is unlikely to be a widespread public health threat in this country.

There’s bad news, however. Another, less flashy threat to public health is far more dangerous to people in North Carolina and states like it. (The additional bad news: it’s also deeply troubling that Americans are more concerned about a disease killing one person inside our borders than the nearly 5,000 Ebola has killed in Africa so far. That’s a topic for another day.)

The real public health threat is the failure of some American states, including the Old North State, to expand Medicaid.

Medicaid expansion would help more of our neighbors get health insurance, which is vital in preventing the advance of disease — and the early deaths that come with that disease. Here in North Carolina alone, about half a million people lack health insurance that would have been covered had we made the choice to expand Medicaid.

What does that mean? It means more preventable deaths every year. A team of researchers for Harvard found that failure to expand Medicaid could mean as many as 1,145 more deaths in North Carolina every year.

Based on those numbers, that’s about three more preventable deaths in North Carolina every day. Think about the math of that. Read More

Commentary

The Alliance for a Just Society along with Action NC released a report today titled “The Promise of Quality, Affordable Health Care for Women: Is North Carolina Delivering?” The answer, in a word, is no.

Overall the report gives our state a C- on women’s health when looking at a range of measures from health outcomes to access. Most abysmal is the state’s ranking on health insurance coverage. There we merited a D-. The uninsured rate among non-elderly women in NC is nearly 17 percent. There are also tremendous racial disparities in uninsured rates. Nearly 19 percent of black women are uninsured in the state, according to the report, and almost 39 percent of Latinas are uninsured. Our state ranks 50 out of 50 for uninsured rate among Latinas.

The grades don’t climb much higher from there. On women’s access to health services we earned a mediocre C and on health outcomes we get a C-. This is a report card we might want to hide in the couch cushions.

But there’s good news that could boost our lackluster scores. As the report recommends, expanding Medicaid would put a major dent in our uninsured rate, help close the health disparity gap, and improve outcomes.

NC lawmakers once famously claimed that Medicaid expansion has nothing to do with women’s health. This report card, and hundreds of thousands of women across the state, beg to differ.

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Recent budget proposals out of the NCGA will eliminate Medicaid coverage for nearly 12,000 elderly blind or disabled people, cut $1 million from a popular program that delivers meals and provides in-home health services to the elderly, and shut down several regional offices of the state’s child-developmental services agencies that help babies and toddlers with disabilities.

One submission to N.C. Policy Watch’s “Your Soapbox” feature laments the difficulty in getting help even before the the proposed cuts.

I lost my insurance coverage under COBRA. I went for a year without insurance coverage. I didn’t qualify for Medicaid since I had over $2500.00 in the State Retirement system.

I had to fight tooth and nail to get help. Every way I went was a dead end. I was finally able to get help through Pender County for medical and meds.

It is a crying shame the way the poor and elderly are being treated; it’s like the legislature wants them to die.

Read the full submisson here.

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Do you have a story to tell? We want to hear more from people and their families who stand to be affected by the massive cuts proposed by our legislative leaders to Medicaid and other health and human services programs that serve the poor, disabled and elderly. What are your experiences? Tell us your story using this submission form.

To read personal stories from others affected by the cuts, click here.

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imageA popular theme on the Right is that having Medicaid health coverage is worse than having no health insurance at all.  After all the years I’ve spent traveling North Carolina and meeting people in poverty desperate for basic health care but with no way to pay for coverage I still can’t believe people can make this argument with a straight face.  Well, if you read one thing this weekend, read the incredibly moving story of the hardworking mom in Orlando, Florida who would have qualified for Medicaid but hasn’t because Florida, like NC, has refused to expand Medicaid.  She dropped dead – on a sales call for her vacuum cleaner sales job no less – of an existing heart condition she couldn’t adequately treat because she couldn’t adequately pay for coverage.