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Wos-and-Nichol

DHHS Secretary Dr. Aldona Wos (left), and Gene Nichol of the UNC School of Law (right)

If you missed it over the weekend, there are two-must read stories on where North Carolina stands in expanding Medicaid.

The Winston Salem Journal’s Richard Craver had a sit down interview with state DHHS Secretary Dr. Aldona Wos, in which Wos said she would “soon” be recommending expanding the state Medicaid program to Gov. Pat McCrory.

So, how soon is soon? Craver writes:

“Everyone needs to know that Medicaid expansion is complicated,” Wos said, slowing down to pronounce each syllable in “complicated.” “There is no flipping of a switch.”

She said physical and behavioral health care system expansion must come first so the system is able to absorb additional participants.

“Our state has to have industry adapt to providing enough health-care providers, and that is a process,” Wos said.

Wos said a key element of building DHHS’ foundation is “getting new skills in finance, economists and actuaries, that are absolutely critical to our organization.”

“If I am allowed to continue on this path, I guarantee you we will have that foundation. The rest of the process is building upon that foundation with standards, with flexibility built in.”

“We’re not too far away. Soon.”

Gene Nichol,  director of the UNC Center on Poverty, Work and Opportunity,  – who does not speak for UNC – wrote in Saturday’s Raleigh News & Observer that the longer the state goes without expanding Medicaid, the more lives are lost.

Here’s an excerpt from Nichol’s opinion piece:

‘The consequences for poor people of being excluded from health care coverage are real and dramatic. Losses in health, losses in emotional well-being, losses in financial capacity, losses in opportunity. And, for some, it’s worse.

A recent Harvard study indicates a significant number of our sisters and brothers will experience premature and preventable deaths as a result of the General Assembly’s rejection of Medicaid expansion. Many “low-income women will forgo breast and cervical cancer screenings, diabetics will (fail to receive) necessary medications,” blood pressure pills and other preventative measures will be denied, “diagnosis and treatment of depression” will be diminished.

As a result, the scholars estimate, the number of Tar Heels who will perish at the hand of our politics may well exceed a thousand a year. The wound inflicted by the Medicaid vote is grievous, deep and sometimes mortal.

I’ve wondered how it feels to cast a vote that means thousands might needlessly die. I can’t get my arms around it. Looking in the mirror must become tougher duty. I can see not wanting to dwell on it.

But when you make a decision that means people may lose their lives, surely you have to do more than offer empty slogans and nonsense-laden talking points to defend it. Surely you have to show you’ve done something more than merely taken instruction, more than mindlessly repeated what you’ve been told – like some malfunctioning teleprompter.

At least you ought to show that you’ve thought it through for yourself. That you’re not just siding with one gang or the other or proving your antipathy for various adversaries.

When politics becomes lethal, responsibility ascends.’

Read the full story in the Winston-Salem Journal here, and the full Point of View column by Nichol here in the News & Observer.

(Note: Nichol is a board member of the N.C. Justice Center, the larger anti-poverty non-profit that N.C. Policy Watch is a part of).
Commentary
Obama window

Pres. Obama and a staffer hail Rose Garden maintenance team to join them at today’s press event. Photo: www.whitehouse.gov

President proposes heath care expansion financed by rich liberals, people of color and immigrants
Conservative leaders skeptical that tax plan is sufficiently targeted

WASHINGTON - In an effort to break the logjam that has kept millions of Americans in numerous states from fully participating in all aspects of the Affordable Care Act, President Obama announced today that he would offer yet another olive branch to conservative critics of his signature health plan.

Under a new initiative the President referred to as the “Keeping Our Citizens Healthy by Selling-out Wholesale If Necessary” plan or “KOCHS WIN” for short, Medicaid expansion and other costs associated with the Affordable Care Act would be underwritten as of January, 2015 via a series of new taxes to be levied directly on three of Mr. Obama’s most loyal groups of supporters: liberal billionaires, people of color and immigrants. The President announced the new plan today at a White House ceremony in which he was joined by Warren Buffett, Bill Gates, George Soros and a several members of the Rose Garden maintenance team.

According to Mr. Obama, the KOCHS WIN plan was just his latest good-faith effort to do whatever it takes to find common ground with critics who have fought the Affordable Care Act and virtually every other initiative of his administration since it took office in 2009, even when the initiatives in question were originally the critics’ ideas.

“My administration has compromised so much on so many things at this point – Iraq, Guantanamo, taxes, trade, reproductive rights, immigration, gun control, just to name a few – that this one was really a no-brainer,“ said the President. Hearkening back to a theme that has arisen repeatedly over the last five and a half years, Mr. Obama declared that “there are very few principles of progressivism and good governance that we aren’t prepared to sacrifice in order to get a deal and maybe save some lives.”

New tax schemes

Under the plan, which Mr. Buffett claimed to have first suggested to the President during toasts at a White House state dinner for African leaders last month, each of the growing number of billionaires who have contributed to the President’s Organizing for Action advocacy group and its affiliated nonprofits, plus those who are registered as Democrats or who have significant holdings in the film industry, will pay a special one-time surtax of 3% of their net wealth.

“Heck, I told the President that Bill, George and I ought to probably just pay for the whole darned thing ourselves,” said Mr. Buffett. “But he said ‘no, if we’re going to have a shot at getting this through we can’t let ourselves be accused of engaging in class warfare.’ That’s when someone – I think it was Harry Reid – suggested a small tax on some other groups conservatives love to hate. ”

Those other groups, under the initial version of the KOCHS WIN plan, would be immigrants and lower-income minorities – both of which would be targeted for new federal excise taxes. Read More

Commentary

Health-Reform-SBFinding irony and contradictions in the arguments espoused by Obamacare haters is not a difficult thing to do. Heck, one of the nation’s most powerful opponents of the new law is trying to force its repeal even as he embraces its remarkably positive impact in his home state!

That said, a new issue brief from the Center for Economic and Policy Research points to an especially interesting and problematic finding for opponents who continue to lambaste the law as an “assault on freedom”: the law is actually enhancing freedom. It’s doing this for millions of average Americans in a vitally important way by expanding their choices when it comes to how, when and where they work. Here’s the introduction:

“Most of the discussion of the Affordable Care Act (ACA) has focused on the extent to which it has extended health insurance coverage to the formerly uninsured. This is certainly an important aspect of the law. However by allowing people to buy insurance through the exchanges and extending Medicaid coverage to millions of people,
the ACA also largely ends workers’ dependence on their employer for insurance. This gives tens of millions of people the option to change their job, to work part-time, or take time off to be with young children or family members in need of care, or to retire early. Read More

Commentary
Cover me

Image: NC AIDS Action Network – www.ncaan.org

A new report from the Pew Charitable Trusts makes clearer than ever just how mean-spirited and morally bankrupt the decision of state lawmakers and Governor McCrory to turn down federally-funded Medicaid coverage for hundreds of thousands of  low-income North Carolinians is turning out to be. The report, “Southern States Are Now Epicenter of HIV/AIDS in the U.S.” tells the story of a woman from New York named Deadra Malloy who had successfully managed her HIV infection for decades while living in New York where public subsidies made medication affordable. When she moved to North Carolina and then South Carolina, however, all that changed. Soon she was skimping on necessary drugs and quickly wound up in the hospital with pneumonia.

As the story notes, the woman’s case is sadly typical:  Read More

Commentary

Medicaid expansionOur old NC Policy Watch colleague Adam Searing had a great post last week on the Georgetown University Health Policy Institute blog, Say Ahhh! that explains why Medicaid expansion is fast reaching the tipping point as states that once said “no” are now seeing the light. Let’s hope North Carolina come to their sense soon.

It’s getting harder and harder for Governors to say no to the great deal being offered to them through the Medicaid expansion option.  Just last week Pennsylvania reached agreement with the federal government on a Medicaid expansion waiver and news stories show possible movement in Wyoming, Utah and Tennessee.

This new momentum forward shows that more state leaders are willing to stand up to those with intransigent ideological views to find a common sense approach towards managing their state’s finances and health care system.  Three factors are driving the change:

Hard Numbers

Before January 1, 2014 – the first day states that accepted the federal Medicaid expansion could open their programs – the costs of not doing so were largely theoretical.  Now that a growing majority of states have expanded coverage, the choice on Medicaid is no longer a hazy public policy debate but one where hard numbers on the cost of not expanding coverage are now available between the states that expanded coverage and those that have not. Read More