You should read our earlier post about Rep. Nelson Dollar’s excellent objections to Medicaid reform. Dollar deserves kudos for pointing out that our system is not broken.

Despite these objections the legislature is charging ahead. If we want reform, however, the state needs to expand Medicaid at the same time. Why? Because to reform Medicaid we need permission from the federal government. According to the bill passed by the General Assembly we will officially seek this permission from the federal government by June of 2016. The Obama Administration is unlikely to make privatizing our Medicaid program a major priority in its last few months of office. That is not the sort of legacy he is interested in leaving.

If we do not get approval from the current leadership at Health & Human Services then North Carolina will need to wait until a new President takes office. Then the new President will have to nominate an HHS Secretary and we will have to wait for the Secretary to be confirmed. At some point after that HHS will begin to review our reform proposal.

Alternatively, North Carolina could include expansion in the reform plan. Then the Obama Administration would act quickly to approve our waiver. Certainly HHS is not excited about dismantling our model Medicaid system, but they could live with legislative changes if it meant covering 500,000 more people in our state.

With expansion reform will move quickly and our proposed changes will be accepted by HHS. Without expansion reform will be a long, long road to an uncertain destination.


MedicaidThe endless 2015 legislative session appears, mercifully, to be nearing a conclusion after nine long months. With the passage of the budget early this morning, legislators are now free to wrap up final details and adjourn for the year. Unfortunately, one of those final details will be giving away the state’s award winning Medicaid program to giant, for-profit insurance companies. As Lynn Bonner reports this morning in Raleigh’s News & Observer:

“Legislators have agreed to privatize North Carolina’s $15 billion Medicaid program, a change that doctors and hospitals have been fighting for months, but which some Republican legislators have championed as a remedy for unpredictable spending.

Under House bill 372, three insurers would be given contracts to offer statewide Medicaid managed care plans. The state would have up to 10 contracts with “provider-led entities,” or groups of doctors and hospitals, that would enroll patients in regional managed care networks.

Rather than pay for each hospital visit or medical procedure as it does now, Medicaid would give the companies a fee for each patient when they enroll. The government would not be liable for cost overruns.”

In many ways. of course, this is a perfectly apt conclusion to the session. The 2015 session opened nine long months ago with one obvious and overriding imperative: North Carolina needed to follow the lead of 30 other states and expand Medicaid under the Affordable Care Act. Such an act would have saved thousands of lives per year, pumped billions of dollars into the state’s economy and strengthened an already highly effective program. The state’s feckless governor admitted these facts at times even as he manufactured excuses not to act.

Now, however, the decision has been made to, essentially, do the opposite. Rather than expanding the program to save lives, state leaders will heed the siren song of fat cat corporate lobbyists and give away this enormously valuable public asset to a handful of giant corporations that will, in turn, squeeze profits out of it by denying services to people in need.

The bottom line: More poor people will die, our economy will suffer unnecessarily and wealthy, out-of-state corporations will pad their profits. It’s hard to think of a concluding act that better symbolizes the awful 2015 session.


North Carolina’s uninsured rate fell in 2014 thanks to the implementation of federal health reform but data released today show our state is leaving many citizens behind by refusing to expand Medicaid.

The Census Bureau today released the country’s official data on health insurance rates, which shows that 1.27 million North Carolinians lacked health insurance in 2014 compared to 1.5 million uninsured North Carolinians in 2013. Expanding Medicaid would have resulted in a more dramatic drop in the uninsured rate.

We see that many of the states that expanded Medicaid such as West Virginia and Kentucky now have single-digit uninsured rates whereas North Carolina’s uninsured rate was 13 percent in 2014 compared to 15.6 percent in 2013. The Affordable Care Act is working, but it would work better if policymakers stopped blocking coverage for the working poor families who don’t earn enough to buy private insurance and don’t currently qualify for Medicaid.

A study by George Washington University released last year shows that expanding Medicaid in North Carolina would extend coverage to 500,000 more people while creating 43,000 jobs and attracting $21 billion in federal funding over five years.

Nationally, the Census data show that the uninsured rate dropped to 10.4 percent last year, down from 13.3 percent in 2013. These numbers reflect individuals who were uninsured throughout the year. The Affordable Care Act helped more than 8.8 million people gain health insurance coverage.

It’s not too late for North Carolina to catch up with the rest of the nation. The Governor could propose, and the legislature could adopt, a state-specific plan to close the coverage gap at any time.

Commentary, Uncategorized

The North Carolina Justice Center launched radio and digital ads this week urging people to ask Gov. Pat McCrory to release a plan that expands affordable health insurance in our state.

We have the opportunity to tap federal funds to extend affordable insurance coverage to more than 500,000 people struggling to pay for care. Our tax dollars are sitting in Washington waiting to be used to boost rural health care in our state and save more than 1,000 lives every year.

We can expand Medicaid with this money or we can develop a state-specific plan to experiment with new coverage ideas. Conservative Governors in Arkansas, Iowa, Indiana, Montana, Utah, Tennessee and elsewhere have proposed specific policies. Gov. McCrory told news outlets at the beginning of the year that he was considering doing the same. The hold up, he claimed at the time, was the latest Affordable Care Act challenge at the U.S. Supreme Court. He would announce his support, or opposition, to expanding coverage after the high court ruled in King v. Burwell.

King v. Burwell came and went and still no word from the Governor.

The Governor and legislators all have access to taxpayer funded healthcare so they can afford to delay a decision. Many others in our state aren’t so lucky.

These 500,000 North Carolinians are mostly the working poor with jobs in construction and food service that do not provide health insurance benefits. They don’t currently qualify for Medicaid because eligibility is restrictive in our state. They can’t afford to buy private insurance. Now they are stuck and just need action from their elected representatives.

It starts with the Governor. He can change the dynamic by showing leadership and proposing a plan. Go to NC Left Me Out and share your story if you or a loved one are in the coverage gap. And then use the phone number listed to contact Gov. McCrory and ask him, “Where’s the plan to expand coverage?” We can’t wait any longer.


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.