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Notwithstanding the unceasing efforts to undermine and obstruct the Affordable Care Act, America’s health care law continues to pile up an impressive list of accomplishments. The latest was detailed this morning in this post by Tara Culp-Ressler at Think Progress:

“For the first time in a decade, the number of people struggling to pay their medical bills has started to decline, according to a new survey released on Thursday by the Commonwealth Fund. The researchers attributed the historic drop to the number of people gaining insurance under the health care reform law.

Between 2012 and 2014 — as Obamacare’s main coverage expansion took effect — the Commonwealth researchers found that the number of people who had issues paying for health treatment dropped from 41 percent to 35 percent. Over the same time period, the people who skipped out on health services because they couldn’t afford them declined from 43 percent to 36 percent:

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CREDIT: Commonwealth Fund

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CREDIT: Commonwealth Fund”

Commentary

poverty916-1Today’s nominee for most maddening, hypocritical and self-serving tradition in the world of politics is the spectacle of politicians who dedicate the their professional lives to de-funding public services — especially those that serve people  in need — solemnly preaching to us on holidays and/or when the weather is bad about the importance of helping the poor.

Here’s North Carolina’s ultra-right, anti-public safety net Lieutenant Governor this morning on Facebook:

“With these incredibly low temperatures sweeping across our state, let us not forget all of those less fortunate than us. Last month First Lady McCrory and Alice Forest teamed up with the Durham Rescue Mission for a canned food drive. We have been informed that over 2,500 cans of food were collected, and nearly $2,000 donated!

With the cold weather we are experiencing this week, the Durham Rescue Mission is expecting an influx of people. Thank you to to everyone who donates their time and resources to causes like this across our state. Your generosity will ensure that nutritious meals will be available for all who come.”

Isn’t that special? The same fellow who crusades on an almost daily basis against Medicaid expansion, unemployment insurance and any number of other essential safety net programs that would actually make a difference for low income people is all about tossing a few cans of food (and maybe a night in a shelter) to the poor when the weather is bad.

Chris Fitzsimon rightfully described this noxious phenomenon this past Thanksgiving as “cynically suspending the blame.”

“But there’s a disconnect somehow in the holiday message and the rhetoric we hear from many political leaders and right-wing pundits the rest of the time.

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Commentary

As noted below, Gov. McCrory met with President Obama to discuss flexibility in using Medicaid expansion money to implement a North Carolina specific program that will extend health insurance to more low-income residents. As we have also said, the federal government has shown a tremendous willingness to accommodate governors who request authority to design new and innovative programs. This is all encouraging and kudos to the Governor for sticking his toe in the water.

What is not encouraging is McCrory floating the idea of work requirements as a condition to receive health insurance. As McCrory notes in the article, Utah’s Governor has pushed this idea unsuccessfully. Our Governor feels that President Obama may reconsider his opposition to this idea. That will not happen.

As background, an 1115 waiver allows states to waive some traditional protections in Medicaid to experiment with new ideas that can improve this important health insurance program. Specifically, waivers are meant to promote the ultimate objectives of Medicaid. Several states, for example, now have waivers to purchase private insurance plans for low-income people who would be eligible for Medicaid under expansion. This is an interesting and worthwhile experiment and we will collect important information on outcomes and costs from these state innovations.

Some Governors are abusing this process by applying for 1115 waivers that do nothing but erect barriers for people who need health insurance. A prime example is requesting a waiver that requires people to report to work search programs as a condition of receiving health insurance benefits. This is not innovative. It is not new. We know what happens when you include work requirements as a condition for receiving public benefits. It means many people will not be able to access insurance.

The waiver approved in Pennsylvania includes a provision that automatically refers unemployed people to job programs when they enroll in insurance. That’s fine as long as insurance is not contingent on participation in the work program.

We know, for these reasons, that a work requirement will not be approved by the federal government. There is some concern that Gov. McCrory may use this as a poison pill to sink a Medicaid expansion proposal and then blame the Obama Administration for not showing enough flexibility. Let’s hope that’s not the case.

Gov. McCrory has plenty of room to create a North Carolina specific plan to cover low-income people in the state. He should drop this one idea that everyone knows will never get approved and move forward with an evidence-based, innovative policy.

Commentary

A new report from Cone Health Foundation and Kate B. Reynolds Charitable Trust finds that North Carolina lost out on billions of dollars and thousands of jobs by refusing to close the Medicaid coverage gap in 2014 and 2015. If the state acts in 2016, however, we can recoup some lost ground by covering 500,000 more people. Such a move would create 43,000 new jobs by 2020 and reap $1 billion in tax revenue for the state and counties. Closing the coverage gap would save the state budget more than $300 million by 2020.

As followers of this blog know the state had a chance, starting in 2014, to expand Medicaid eligibility to all individuals and families earning less than 138 percent of the federal poverty level. More than half the states have now opted into this deal and they are attracting a huge return on investment. This new report is the first of its kind in the nation that takes a detailed look at every county in the state and uses a nationally respected model to estimate the impact of Medicaid expansion on tax revenue, job creation, business activity, and coverage.

The results are startling. In Robeson County expanding Medicaid would generate more than 700 jobs. In Moore County it would create nearly 500 jobs. In Nash County it would create more than 300 jobs. This is the equivalent of a fleet of new large employers locating in dozens of communities across the state. The increased economic activity will produce more county tax revenue at a time when many local governments are sputtering by on fumes. For Wake County, Medicaid expansion would net more than $25 million in tax revenue. It would earn Guilford County more than $11 million.

New data confirms in finer detail what we have always known, expanding Medicaid eligibility is a no-brainer. Thankfully, Gov. McCrory seems to be moving to the right (or should I say correct) side of this issue. Now that the federal government is allowing governors and legislators the flexibility to design state-specific expansions Wyoming, Indiana, Utah, and Tennessee — hardly redoubts of liberalism — are starting to embrace expansion. We should follow suit.

This is a rich report that deserves a close reading. You can find some reporting on it here, here, here, and here.

 

 

News

There’s an interesting article today from North Carolina Health News about fast-food workers who make too much to qualify for Medicaid in North Carolina but make too little to afford health care on their own.

North Carolina is one of several states that declined to expand coverage of Medicaid in the state, after the state legislature passed a law in early 2013 preventing  expansion that Gov. Pat McCrory signed.  The situation has left hundreds of thousands of low-income workers unable to afford health care on their own and without access to the federal subsidies that would make health care more affordable.

Among those people are a 35-year-old Durham man whose worked for a decade making pizzas at Dominos.

From the article, by Hyun Namkoong:

The Feb. 15 deadline to sign up for health insurance coverage on the federal Healthcare.gov website is quickly approaching, and low-wage workers like DeAngelo Morales and Isaac McQueen are stuck between a rock and hard place.

McQueen, 35, a father of two, has worked at Domino’s Pizza for 10 years as a pizza maker. He says he doesn’t qualify for subsidies offered under the Affordable Care Act. He also doesn’t qualify for Medicaid after North Carolina declined to expand the program to adults who make more than 49 percent of the federal poverty level, which works out to $9,697 a year for a family of three.

“I [make] too much money,” he said with an ironic laugh.

McQueen said there was a plan on the federal health insurance exchange that cost $80 a month, but he couldn’t afford it.

Instead, his health insurance plan is based on hope and faith.

“[I’m just] hoping and praying to God I don’t get sick, because I can’t afford any substantial medical bills,” he said.

 

You can read the entire piece here.