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Health numbersThe legislative debate over Medicaid reform over the last two weeks once again revealed the Senate’s misplaced priorities – profits over people. The health of North Carolinians was not only compromised by pushing reform that employs commercial insurers and dismantling Community Care North Carolina (CCNC), but also by failing to expanding Medicaid to the half million people in the Coverage Gap. It is surprising that for a governing body that focuses most of its efforts on profits, the Senate fails to recognize the economic benefits of Medicaid expansion.

Unfortunately, many conservative policymakers agree with Sen. Harry Brown when he stated, “Every state that has expanded Medicaid has created a financial problem in their state budgets” during the expansion debate. Black and white statements like his fail to present the complete and complex picture of each state’s expansion experience. To present a more accurate picture, the Health Access Coalition created a chart outlining the successes and challenges for each of the 30 states and DC that has expanded Medicaid. The chart also provides information on whether the state used a waiver to expand Medicaid. Waivers allow states to tailor Medicaid expansion to meet specific state needs and even include Medicaid reform.

After reviewing this chart, it becomes clear that the biggest challenge states have experienced is providing health coverage to more people than expected – being able to reduce a state’s uninsured rate to 5 percent should be noted as a success! Further, “over-enrollment” proves that need for health care is great and that the long term benefits will be even greater. However, expansion is complex and along with increased enrollment comes budget concerns for the years when the federal match for expansion lowers from 100 percent to 90 percent starting in 2020. Even though states have to reassess their budgets and establish tools to cover Medicaid costs such as hospital assessments, there are several states that have experienced an economic boost. For example, Arkansas reports a combined savings of $120 million between fiscal years 2014 and 2015 due to expansion. Arizona has also gained of over $30 million in new revenue. Colorado has created 20,000 jobs since Medicaid expansion. One county in Illinois has seen a decrease of $158 million in costs associated with providing care to people without health coverage. Other states like New Hampshire are seeing reduced use of emergency rooms as health services are finally being provided to individual that face many barriers to health care for health concerns such as substance use and mental health.

Unlike Sen. Brown’s sales tax distribution plan, Medicaid expansion will have economic benefits for all 100 counties in North Carolina. Sen. Brown’s district, District 6, includes Jones and Onlsow counties. Failing to expand Medicaid by 2016 will cost Jones County $8.4 million less in business activity, $5.6 million less growth to the county’s economy, and $155.8 thousand less in tax revenue between 2016 and 2020. In Onlsow County, there will be $53 million less to the county’s economy, $77.3 million less in county business activity, and $292.9 thousand less in county tax revenue between 2016 and 2020 without expanding Medicaid. The most important benefit to these counties is that over 5,000 people will gain access to health care, but just in case North Carolina’s health benefits aren’t convincing, expansion will allow for $21 billion in federal funds to enter North Carolina.

Commentary

There are several contenders this week for most egregious recent example of conservative hypocrisy when it comes to the role and value of government.

There’harry browns the phenomenon of ultra-conservative lawmakers from rural areas (like state Senate Majority Leader Harry Brown) who deride government day after day and then, suddenly, when faced with a debate over divvying up state sales tax revenue, turn passionate about the critical role that public investments play in supporting the economy and growth.

And then there’s the spectacle of longtime anti-government ideologues like Raleigh’s Paul Coble who never met a public program they didn’t want to slash being only too happy to swap their private industry lobbying gigs for six-figure government jobs.Paul Coble

For my money, though, this week’s most aggravating example comes once more from the office of Gov. Pat McCrory. Gov. McCrory, as  you will recall, has been helping to deny decent and affordable health care to hundreds of thousands of struggling North Carolinians for almost three years now by refusing to expand Medicaid under the terms of the Affordable Care Act.

His oft-statPat McCrory 4ed excuse: the supposed unreliability of federal money and desire not to grow the size of a supposedly broken government program. Add to this his absurd refusal to acknowledge the huge stimulus impact that adding billions in federal dollars would have on the state economy and you’ve got a complete, far right, market fundamentalist case of denial.

Now, contrast all of this with McCrory’s big announcement yesterday touting the huge, beneficial impact of federal spending on the military in North Carolina. Here’s the lead from the press release:

“The military supports 578,000 jobs in North Carolina and more than two thirds of those jobs are in the private sector, demonstrating the impact of the military ripples across the state’s economy and not just concentrated near military installations. Those are the key findings of a new report released today by the North Carolina Military Affairs Commission and the North Carolina Department of Commerce.”

You got that? The same administration which has devoted years to blasting the idea of federal dollars helping the economy and spurring growth by supporting loads of good jobs in the health care industry is…wait for it…celebrating the idea of federal dollars helping the economy and spurring growth by supporting loads of mostly so-so jobs in the U.S. military. Read More

Commentary

Last week the Senate released its latest version of Medicaid reform calling it a compromise measure with the House. There are some changes to the Senate’s original proposal.

Under the amended plan a new Department of Medicaid is created but it remains within the Governor’s purview. It also allows for regional provider led entities to compete for Medicaid contracts with statewide managed care companies. For the most part, however, the bill is a radical revamping of Medicaid. It is difficult to see how adding all of this complexity will increase predictability. Instead, this restructuring creates a system with many moving parts that will require a new oversight regime. In the end patients are likely to get pinched between gaps in this structure and the state will spend time and money tracking problems and pursuing legal claims against private insurance companies.

Due to consolidations in the industry there are not many insurance companies that will bid to control Medicaid delivery in the state. Companies like Amerigroup and Centene and United HealthCare will likely get contracts under the Senate plan. North Carolina will get glittery promises and great deals in the first year. Then the problems will start.

Whether it’s discriminating against pregnant women, or improperly denying speech-therapy services for children, or denying patients timely access to critical medical services,  or delaying payments to doctors and hospitals, or pulling out of a state before completion of a contract, private managed care companies introduce a  great deal of uncertainty.

Although the Senate allows regional provider led entities to form, these organizations have major disadvantages when trying to compete with large corporations. The provider groups, for example, must meet the solvency requirements of a private insurance company. They must also move within a year to take on full risk. That means if they give too much care at too much cost the providers are stuck. They only get the amount of money they originally budgeted. This is not a huge problem for an insurance company with billions in revenue. It is more difficult for a small collection of rural clinics and hospitals. Also, if a big insurer is losing money it can pull out of the state never to return. Not so with a doctor’s office.

The Senate persists in wanting to end contracts with Community Care of North Carolina, our state’s Medicaid medical home model that has won national recognition.

It is difficult to see what problem the Senate hopes to solve by injecting so much complexity and uncertainty into the system. Trying to negotiate with large insurance companies and regional provider entities will introduce opportunities for fraud, waste, and abuse. It will also mean a major loss of state control over our Medicaid program.

The biggest beef legislators have had with Medicaid is the agency’s difficulty in projecting costs. Now that private insurance companies are having to deal with constant policy change, and now that they can’t cherry pick customers, we are seeing that they also have trouble predicting costs. Tearing down our entire Medicaid structure to get more reliable budget numbers seems like a bit much. We could, after all, move to a full-risk capitation model using provider agreements and CCNC.

Ultimately, the most short-sighted part of both the House and Senate proposals is that neither includes expanding Medicaid eligibility. Most states across the country are now expanding and reforming Medicaid at the same time. This allows governors to negotiate more conservative reform deals with the federal government. If we are going to ask patients and providers to undergo a painful reform process we could at least cover more people.

Commentary

Moore_15cRaleigh’s News & Observer ran a big profile of House Speaker Tim Moore over the weekend in which it highlighted the fact that Moore’s tenure has not quite matched the hard right ideological fervor of his predecessor, Thom Tillis, or the current leadership of the state Senate. At times, he’s even worked with Democrats to help pass some measures, including the budget and the recent state bond package. In addition, he’s made somewhat less use of the abusive tactics favored by Tillis for shutting down debate and occasionally has raised the ire of some fire-breathers on the far right.

Before observers get too carried away with this portrayal, however, it’s important to note that it says a lot more about how bizarrely extreme the modern right wing has become than it does about any significant moderation by Moore. By any fair assessment, Moore’s politics remain far to the right of Ronald Reagan. Consider the following items and issues on which Moore has adhered to or advanced a downright reactionary agenda:

Medicaid expansion:  On the single most important issue before state government — a policy change already enacted by Republicans all over the country that could save thousands of lives and lift up the state economy — Moore continues to do nothing.

Public education: Moore continues to help advance the Right’s pro-voucher, pro-charters privatization agenda and has done little-to-nothing to repair the damage inflicted on K-12 funding in recent years.

Environmental protection: Under Moore’s leadership, the list of proposals to gut environmental protection just keep on coming.

Taxes: Though he has not yet completely embraced the Senate’s extreme efforts to mimic the suicidal policies of states like Kansas, Moore continues to support additional tax cuts for corporations even as the state struggles to meet its most basic needs. He’s also done nothing to repair the damage caused by the  destructive 2013 tax cuts or to reinstate the critically important Earned Income Tax Credit.

LGBT equality, reproductive rights, the death penalty, guns: And, of course, Moore has promoted the far right “social agenda” on each of these issues in 2015, including: the discriminatory “religious freedom” law for magistrates and registers of deeds, the bill to up the state’s absurd  abortion waiting period, the bill to keep death penalty drugs shrouded in secrecy and the bill to introduce concealed weapons into even more venues.

The confederate flag: Moore has done nothing to end the state’s embarrassing display of the rebel flag on license plates and has made it harder to remove confederate memorials.

The bottom line: Speaker Moore may be an affable guy who takes it a tiny bit slower than some when it comes to the most extreme components of the far right agenda, but in a world in which much of the modern American Right backs Donald Trump for President and openly consorts with groups and individuals that favor “nullification” of federal laws, this should not be confused with “moderation.” On issue after issue, Moore continues push North Carolina dramatically and rapidly backwards.

Commentary

Columnist Myron B. Pitts of the Fayetteville Observer has an excellent, if sobering, essay this morning about the North Carolina General Assembly. It’s entitled “State’s decisions, from bad to abysmal” and it attempts to rank the worst decisions made by North Carolina lawmakers over the past half decade. Admittedly, Pitts has carved out a daunting task for himself, but see if you agree with his list, which starts with the awful 2013 tax changes and runs through the death-promoting decision to deny health insurance to hundreds of thousands of people.

NOTE: As the General Assembly is still in session, the list may well have to be updated in the coming weeks. Stay tuned and feel free to offer your additions.

Click here to read Pitts’ list.