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Commentary

Medicaid expansionThanks to a report from the American Mental Health Counselors Association, North Carolina along with other states that have not expanded Medicaid have yet another feather to place in their caps – denying access to mental health care for nearly 600,000 uninsured adults that would have sought care last year. Approximately 21,000 of those uninsured adults reside in NC. Even before the debate over Medicaid expansion began, there was the Mental Health Parity and Addiction Equity Act, which has produced a slow push to lessen the gap between how people access and utilize physical and mental health care. Even with mental health parity, over 50 percent of adults with a mental illness did not receive mental health care in NC between 2009-2013. Failing to extend health coverage to individuals with mental illness through expanding Medicaid only increases barriers to treatment, which in turn creates social, physical, and economic burdens to those with mental illness, their families and even their communities.

On the individual level, people living with mental illness are more likely to have other physical chronic conditions, have shorter life expectancies, are poor, and have difficulty finding employment. Students with mental illness, especially those who receive special education, experience school failure and drop out more frequently than other students including students in other disability groups . Without affordable mental health treatment, people with mental illness do not receive preventative treatment and thus rely on costly emergency room visits or even end up in jail.

The families of individuals with mental illness also face burdens as they become caregivers and help pay for expensive out-of-pocket mental health treatment. Unfortunately, the impact on communities resulting from traumatic events like Sandy Hook and Newtown have become too familiar that even the NRA supports policy to enhance the mental health system. On the broader economic level, the National Alliance on Mental Illness reports that the US loses $193.2 billion annually due to lost earnings associated with the sequelae of mental illness.

Treatment received from the public mental health system is especially important as people with mental illness live closer to the poverty line and have unstable employment status. For adults between ages 21 and 64 years that received mental health treatment from the public mental health system, 75 percent were unemployed. For all adults over age 18 that received treatment in the public mental health system, 76 percent reported improved functioning as a result of care. The statistics on employment and mental health may lead some to believe that expanding Medicaid will act as another “handout,” but most adults with mental illness want to work, but lack support to maintain employment. Further, some jobs obtained by adults with mental illness may not offer health care coverage or pay enough to cover out-of-pocket costs. Last year, in states that expanded Medicaid, there were nearly 350,000 fewer people that experienced Major Depression. Hopefully NC legislators will help decrease the burden of untreated mental illness by increasing mental health parity through Medicaid expansion.

Poverty and Policy Matters

There are few situations in life that are clearly win-win. When you see one, you have to take advantage of it.

That’s why North Carolina should reverse course and expand Medicaid. When you have the chance to improve health care for hundreds of thousands of people and actually save money, you should jump on it.

In a recent News & Observer editorial, the paper called the decision not to expand Medicaid “wildly irresponsible and hugely expensive.” That’s precisely correct, and let’s explore the first part of the statement a bit more.

Turning down Medicaid expansion turns down $50 billion in federal funding and prevents roughly 400,000 of our neighbors from getting covered. That makes expanding Medicaid an obvious choice.

But also consider that preventative care saves money over the long run. Insuring people means they get to go to the doctor, which means we pay less to prevent disease. This leads to lower costs for taxpayers and better lives for our people. An excerpt from the N&O piece:

Community Care said in a news release: “The medical costs for low-birth-weight babies average $49,000 in a baby’s first year of life, or more than 10 times more than babies born without complications. A low birth weight also increases a child’s risk for long-term medical and developmental complications and the likelihood of incurring additional expenses for social services and educational needs in later years.”

Kate Berrien, manager of Community Care’s pregnancy project, said North Carolina now leads the South in having the fewest births before 39 weeks. That’s a lot of savings and a vast increase in the quality of life for many children born to low-income mothers. And it’s an achievement attributable to innovations in community-level care that were developed in North Carolina and are being adopted across the nation.

It’s a win-win situation. Tom Wroth, CCNC’s chief medical officer, said, “We’ve been able to align improving clinical quality with lower cost.”

Read that last paragraph again. Improving quality care with lower cost is a win-win. So is expanding Medicaid.

Commentary

Rural hospital closuresWalking not only has individual health benefits, but this exercise can impact the health of an entire community. For the second straight year, Mayor Adam O’Neal of Belhaven is walking to save lives. While Belhaven is home to approximately 1600 people, Vidant Pungo Hospital provided critical care to people throughout Beaufort County and other rural eastern NC counties. Without the hospital, people face additional barriers to accessing care such as taking time off work to travel close to 60 miles round-trip to see a medical provider.

Beaufort County residents are not the only people in rural communities that have difficulty accessing care as 48 rural counties in NC have shortages in primary care. The closings of rural hospitals is a national issue – The Sheps Center at UNC notes that since January 2010, 50 rural hospitals have closed and nearly 300 more rural hospitals around the country are in danger of closing in 2015.

This year’s walk to DC is even more critical as our state faces many decisions that impact rural health –one of which is whether to repeal NC’s “Certificate of Need/ CON” law to allow for a “free market” and to “reduce costs” associated with accessing health care. However, research has shown that residents in rural communities have fewer resources to pay for health care, so it is unlikely that in a “free market” the need for health care services would go to rural counties where residents are more likely to be uninsured. Thus, there is more likely a duplication of services in urban counties. Further, there is research suggesting that states with CON laws report less hospital inefficiency and can even help reduce the length of stay in emergency departments. This new legislation will create more barriers to accessing quality health care in rural communities.

A second hot topic regarding health care is Medicaid expansion. There are many states that have expanded Medicaid either as outlined in the ACA or that have tailored expansion to meet their state’s needs through waivers. Even though states like Kentucky, West Virginia and Arkansas are seeing health and financial benefits, Gov. McCrory has delayed taking action on this issue until a decision has been made on King v. Burwell by the Supreme Court. The longer lawmakers take on extending health care to 500,000 North Carolinians, the more a financial and health hit our state takes. This is especially true for the rural counties in NC. In Beaufort County, over 1500 individuals would gain access to health care if Medicaid is expanded. However, with the hospital in Belhaven closed, where will the residents go to establish a medical home? Will hardworking residents in our rural counties seek primary and preventative care if there are too many barriers to accessing coordinated care or will they wait for more costly emergency care? Just like repealing or tweaking NC’s CON law, refusing to expand Medicaid affects hospital closures and thus increases health disparities.

If you can, please join Mayor O’Neal and walk for the health of Belhaven and all residents in rural communities whose health is negatively impacted by hospital closures. If you are unable to walk, call our Governor to push for Medicaid expansion and keeping our CON law.

Commentary

RWJA new report from Manatt Health Solutions on behalf of the Robert Wood Johnson Foundation finds that states that have tapped federal funds to expand Medicaid are seeing significant financial benefits. By the end of 2015 the savings and revenues across the eight states examined in the report are expected to exceed $1.8 billion.

This is consistent with the county level examination of expansion in North Carolina commissioned by the Cone Health Foundation and the Kate B. Reynolds Charitable Trust. That study, using conservative estimates, found that the savings and revenues more than offset the costs of expansion through 2020.

The states featured in the report — Arkansas, Colorado, Kentucky, Michigan, New Mexico, Oregon, Washington, and West Virginia — had direct budget savings from reduced spending on the uninsured, they experienced increased tax revenue from the new flow of federal funds into the state, and they realized additional savings from switching some existing Medicaid patients into the expansion program.

A source of significant savings, for example, comes from pregnant women. North Carolina has traditionally covered pregnant women in Medicaid up to 185 percent of the federal poverty level. This coverage, however, is only for pregnancy related services. Also, once a woman has the baby she oftentimes loses Medicaid because coverage for parents is quite stingy.

After expansion, pregnant women above 133 percent of federal poverty level would qualify for full Medicaid coverage. And, instead of the lower match rate, the federal government would pay 90 percent of the costs for these women. Once the baby is born many women would then be able to continue coverage through Medicaid. This would result in healthier babies, healthier parents, and major savings for the state.

The report notes that states will also garner savings in behavioral health and among the medically needy population.

States that opted to expand Medicaid early will have the largest benefits, but there are still plenty of positives for states like North Carolina that haven’t hit the leader board yet. The final year for the federal government to pay the full cost of expansion is 2016 so we need to act fast or our people, and our economy, will miss out on a much needed boost.

Commentary

Medicaid expansionIn case you missed it, the best editorial of the weekend dealt with the most important failure of North Carolina’s political leadership in recent years. The essay in Raleigh’s News & Observer was entitled:

NC losing funding and savings with Medicaid holdout: By balking on Medicaid expansion, N.C. forgoes billions of dollars and a chance to cut costs.”

As the editorial noted:

“In medicine, the small things can matter most. And it is the neglect of the small things that can lead to the biggest costs.

That’s why preventative care is so important and early intervention so significant. And that’s why North Carolina’s stubborn refusal to expand Medicaid is so wildly irresponsible and hugely expensive. As a result of its intransigence, the Republican-led General Assembly is struggling to find tax revenue on one end and turning away billions of dollars on the other.”

The piece goes on to explain how North Carolina’s award-winning nonprofit Medicaid manager, Community Care NC, is saving millions upon millions of dollars and thousands of lives already and to lament the toll in both categories that is being taken by the state leadership’s pigheaded refusal to close the Medicaid gap for hundreds of thousands of lower-income, working people. It also cites report which holds up the astounding amount in federal funds the state is foregoing:

“The report estimates that forgoing federal Medicaid expansion from 2013 to 2022 will cost North Carolina $39.6 billion. In addition, the state’s hospitals will lose out on $11.3 billion in federal funds intended to offset cuts in their Medicare and Medicaid reimbursements as required under the Affordable Care Act, which anticipated that all states would expand Medicaid.

That’s more than $50 billion in federal funding forgone over 10 years. Meanwhile, the state would have to spend about $3 billion for its share of expansion. That is a mindboggling deal to refuse so that conservatives can express their pique over ‘Obamacare.’

Republican leaders say they’re worried about being saddled with a higher entitlement cost if the federal government reneges on its promise to pay its full share, but the design and history of Medicaid do does not support that concern. Meanwhile, there are billions of reasons to expand Medicaid now.”

Amen. Read the entire editorial by clicking here.