Commentary

Physician from NC Senate leader’s district makes impassioned plea for Medicaid expansion

deny-medicaid-400x270In case you missed it, a veteran family physician from Senate President Pro Tem Phil Berger’s home county of Rockingham has authored one of the best new pleas for closing North Carolina’s Medicaid gap that currently keeps hundreds of thousands of working North Carolinians uninsured. In an open letter to Berger and Gov. Pat McCrory in the Greensboro News & Record, Dr. Stephen Luking offers several heartrending examples from his own practice about good, honest people whose health and life expectancy have been directly endangered as a result of the state’s stubborn resistance to Medicaid expansion. As he notes:

“These families aren’t ‘takers’ looking for a handout. The working poor are our cousins and our neighbors. They sit with us in the pews on Sunday; their children or grandchildren go to school with ours.

Some have watched well-paying jobs fly to Mexico or China. Some through personal or family circumstance earn meager wages. Some have employers who craftily maintain them under “temp” status or keep their hours worked under 30 hours per week to avoid insurance obligations. Some have reached their God-given potential.

Who are we to pass judgment? The fact is that near-poverty has left all of them uninsurable without Medicaid. Your rejection of Medicaid expansion may have earned you bona fides and high-fives in political circles, but in the real world your decision has harmed these families left and right.”

And here’s the powerful conclusion:

“Like any family doctor who has practiced for 30 years, I know what it’s like to make a decision that leads to the death of a patient. The appropriate intervention gone badly, the symptom after consideration mistakenly reassured. … I can tell you, it cuts like a knife. You face the family and fight back the tears. You wake up in the middle of the night in a cold sweat and wish you had that moment back.

And sometimes one night leads to a dozen. My wife will tell you, it’s a load to carry.

Gov. McCrory and Sen. Berger, you now carry that same weight, whether you will admit it or not. Welcome to this our unfortunate fraternity: those who carry the blood of others on our hands. Like it or not, we are all three members.

Some in Rockingham County will surely die — if some haven’t already — because of your partisan decision to reject Medicaid expansion.

Please embrace our shared humanity. The two of you have the power to get this done.

Re-approach this issue with an open mind and you will experience a change of heart.

Until then, I hope you’ll wake up some nights in a cold sweat, knowing you have committed a terrible wrong. Shame on you for your complicity thus far in denying basic health insurance to the most vulnerable residents of our state.

Shame on the rest of us for letting you get away with it.”

 

Commentary

AIDS Action Network advocate: Medicaid expansion is a life and death matter

PictureChristina Adeleke of the North Carolina AIDS Action Network recently had the opportunity to testify at a North Carolina Department of Health and Human Services public hearing on the McCrory administration’s plan to privatize the delivery of Medicaid services. Afterward, she composed a compelling and personal essay about how the reality of health insurance in 21st century North Carolina and the price people are paying because of North Carolina’s refusal to close the coverage gap.

FYI, there are two more opportunities to speak out at these hearings — tomorrow in Elizabeth City and Monday in Pembroke. Click here for more information.

The moment I realized that Medicaid reform was a “big deal”
By Christina Adeleke, Esq., North Carolina AIDS Action Network

I have to be completely honest, health insurance was not something I really thought too much about until I got older. Like, “you are finally an adult with bills so you need to think about this now” older. As a child, it was not something I actively thought about. One, I was a kid so health insurance was definitely not high on my priority list and two, I was not a “sick kid,” so I only really went to the doctor’s office when I had to get vaccinated or get a physical to play sports at school (which was also rare). It was not until I reached the magic age of 26 that I was faced with the harsh reality that health insurance is necessary. And very expensive.

Like most young adults, my first job did not immediately shower upon me loads of money. I made enough money for bills, essentials, and literally nothing else, including health insurance. When I tried to get coverage under the Affordable Care Act (ACA), the only plans that I qualified for were completely out of my budget. When I tried to apply for Medicaid, I was told that I made too much money to qualify but if I had a child, things would be different, which was puzzling to me. Did the fact that I had a child or not change my very real reality of not being able to afford health insurance? Before I had too much time to seriously weigh those options, I got offered a new job…WITH BENEFITS. To say I was excited would be an understatement. Now, I did not have to load up on vitamins to prevent myself from getting sick or entertain the idea of having a child in order to get health coverage. I assumed that everyone who was struggling to get health coverage was like me and when they found the right job or opportunity, they too, would be covered as well. I was very wrong. Read more

Commentary

Advocates, people in need demand closure of the Coverage Gap as Medicaid “reform” hearings commence

Medicaid expansionNorth Carolina’s Department of Health and Human Services has a busy few weeks ahead as it commences a series of public hearings around the state concerning its plan to privatize the state Medicaid program and obtain a waiver from the Federal government that would approve the scheme.

Yesterday, a large crowd attended the first public hearing session in Raleigh (click here to see the schedule and sign up to attend future public hearings). The hearing was attended by health care providers, administrators, advocates, current Medicaid enrollees, and individuals that would benefit from Medicaid expansion. Unfortunately, only two legislators, Rep. Marilyn Avila and Sen. Floyd McKissick Jr., were in attendance to hear what people have to say about reform.

One message that rang clear during yesterday’s event was that North Carolina cannot truly transform Medicaid without first expanding the program to the approximately 500,000 people in the Coverage Gap. At the hearing, roughly a third of all of the comments offered called for Medicaid expansion as has been done in so many other states under the terms of the Affordable Care Act. Speakers representing organizations such as the American Heart Association, Carolina Jews for Justice, the League of Women Voters, and even a student from NC Central University all spoke on behalf of the child care workers, construction workers, and home health aides that work, but are stuck in the gap.

Before opening the floor to public comment, DHHS Secretary Rick Brajer explained that he and his team have been “crowd sourcing the development of the waiver.” Brajer even presented a slide listing all of the key “stakeholders” that his department has met with during the preparation of the waiver request.

Unfortunately, one group that was clearly missing from the Secretary’s list were the people in the Coverage Gap. These voices need to continue to be heard as access to quality and affordable health care not only positively impacts individual and family health, but community health as well through job growth and economic development.

In the weeks ahead, look for more and more advocates and potential beneficiaries of expansion to speak out for this kind of genuine reform.

  • Providers will push for Medicaid expansion so that their patients will no longer have to rely on emergency care and actually be able to obtain primary preventative care.
  • Health administrator concerned with health care costs will push for expansion as states with expansion have seen a decrease of 26 percent in uncompensated care costs.
  • School teachers will push for expansion because they know that their students will have increased educational outcomes if their parents/caregivers receive Medicaid.
  • Business owners will push for expansion because good health is closely linked to job productivity .

For more information on how you can be a part of the effort to help push for Medicaid expansion and meaningful reform, click here to learn more about the hearings and here to submit comments online.

Commentary

The case for Medicaid expansion just keeps getting stronger

Medicaid expansionState Medicaid reform could be an opportunity for expansion
By Liz Millar, Medicaid Expansion Project Coordinator at the N.C. Council of Churches

(Cross-posted from the N.C. Council of Churches blog.)

Several public hearings have been planned around the state over the next few months to receive public input on the new plan for Medicaid reform. The plan would move Medicaid, the state program that serves about 1.9 million North Carolina residents, from a fee-for-service format toward a managed-care format.

Under this change, Medicaid recipients can enroll in what the plan’s authors have called “a prepaid health plan” where a flat fee would cover all medical services for most recipients. Senate Republican leaders say they feel the plan for reform will provide better budget predictability by capping the amount spent per person per year.

Projections regarding the success of the reform plan are mixed. Medicaid reform has already been approved in the state and became law in September 2015. However, the details of the plan must be approved by the federal Center for Medicare and Medicaid Services before it can be implemented. While the state legislature is on track to present the reform plan by June 1, the federal approval could take years, especially as individual state plans for reform have not been a priority for the current administration.

What has been a priority, however, is Medicaid expansion. As our legislature still has not moved on accepting millions of dollars in federal funding to expand Medicaid coverage, an opportunity presents itself to combine the state plan for reform with one for expansion.

A plan for reform with expansion in NC has the potential to take priority at the federal level and fast track the plan’s approval. And while the benefits and costs of reform are still under scrutiny, the benefits of expansion, which include expanded health care coverage, economic stimulus, tax revenues, and job growth, are clear.

Medicaid expansion supporters around the state are mobilizing to attend the public hearings and let our voices be heard. This is a crucial opportunity to move on closing the health care coverage gap and urge our legislature to accept federal funding to do so.

The NC Health Access Coalition is working to circulate talking points for supporters of expansion who would like to attend the hearing. We are in need of point people at each of the twelve hearings. Please contact Liz Millar at liz@ncchurches.org for more information or if you’d like to serve as a point person or attend a hearing in support of expansion.

Commentary

Editorial: McCrory out of excuses on Medicaid expansion

There is plenty of room for argument as to whether the state Medicaid system was ever “broken” as claimed by some and why expenditures are now down, but there is one thing this development says for certain: Gov. Pat McCrory is out of excuses for not expanding the program to cover hundreds of thousands of the uninsured.

This morning’s lead editorial in the Fayetteville Observer explains:

[U]nlike some of his GOP brethren in the General Assembly, Gov. Pat McCrory wasn’t an ideologue about [Medicaid expansion]. It was clear that he saw the benefits of an expansion, which mostly would be funded by Washington. Without it, hospitals would face greater financial pressures, and the ‘working poor’ would continue to show up at emergency rooms for medical care because they still couldn’t afford health insurance.

McCrory took a pragmatic approach. Medicaid in North Carolina, he said, was a ‘mess’; it was ‘broken.’ It was all of that, with annual cost overruns in the hundreds of millions. It was hard to justify expanding a broken system and growing those deficits any further.

But the system isn’t broken anymore. It’s under control. As of the end of December, the governor announced in a press release last month, Medicaid was $181 million under budget. Yes, under budget by the same kind of numbers that it once exceeded its budget….

With that accomplished, McCrory’s only good objection to Medicaid expansion is gone. So are his precedents: many of his fellow Republican governors. That includes Ohio Gov. John Kasich, one of the last GOP presidential candidates still standing. Kasich, a pragmatist, ran the numbers and saw Medicaid expansion creating new jobs, keeping hospitals afloat and, of course, making people in his state healthier.

He took advantage of federal flexibility and designed a Medicaid program that fit his and his party’s conservative principles.

It’s time to do that here. Medicaid expansion will save lives and improve many more. It will save endangered hospitals from shutting down. And it will create thousands of new jobs in the health care industry.”