Commentary

Debunking Medicaid expansion misperceptions

Despite reports from states that Medicaid expansion has had health and fiscal benefits, North Carolina remains in the minority along with 18 other states that have failed to close the coverage gap. Unfortunately, there is still a sentiment that people have to prove that they are deserving of health care coverage, instead of noting how increased access to health care and utilizing health services has positive effects ranging from school achievement to job production. The 2016 Child Health Report also highlights how parental coverage is directly connected to whether children have access to and utilize health care services .

Those who object to expanding Medicaid fail to report that many individuals in the coverage gap are working, but may not work enough hours to qualify for employer-sponsored health insurance. Further, many working adults in the coverage gap have low wage jobs and thus make too little to receive financial assistance to purchase health coverage through the Marketplace. As a family of four in the coverage gap has an income of $33,534, it does not seem that Large Health Savings Accounts (HSAs) are a viable option for families that have other financial priorities.

Failing to expand Medicaid will not only continue to increase health disparities among individuals and families, but also entire communities. The longer policymakers take to close the coverage gap, the more it impacts rural communities’ ability to provide affordable and quality health services. According to the Hospital Strength Index, there are 16 vulnerable rural hospitals in North Carolina. If these hospitals were to close, there would be over 300,000 fewer patient encounters and over 3,000 health care related jobs would be lost. Considering that nearly 30 counties in North Carolina lack primary care providers such as Ob-Gyns, the gap in availability of health services could increase further.

Opponents of closing the coverage gap also cite concerns that individuals that currently obtain financial assistance to purchase health insurance through the Marketplace will shift to “inferior” Medicaid coverage if North Carolina expands Medicaid. However, a report by The Commonwealth Fund, states that Medicaid beneficiaries receive preventative care at the same rate as those with private health insurance. Medicaid enrollees also reported similar rates of satisfaction with their health care experience as the privately insured. What’s more, Medicaid beneficiaries report having medical debt at lower rates than the privately insured. Along with the misperception that people will receive “inferior” care, there is concern there will be increased burden to individuals and families with private insurance through cost-shifting. Overall, Medicaid spending growth is less than private insurance. Additionally, as payment for private insurance and Medicaid services shift from fee-for-service to global payment models, cost-shifting to private insurance beneficiaries is unlikely. Considering that Medicaid reform is transforming to a full risk capitation payment model, this is even less of a concern in North Carolina. Now that North Carolina’s Medicaid program is entering a new phase, it is time to extend Medicaid coverage to 500,000 people in the coverage gap.

Commentary

Why thousands will come to Raleigh tomorrow for the HK on J Moral March

Moral March on RaleighAs was explained here earlier this week, there are lots of excellent reasons to bundle up and head to downtown Raleigh tomorrow morning. In today’s edition of Raleigh’s News & Observer, however, Charles van der Horst, a retired Professor of Medicine at UNC, highlights what may well be the single most important reason: to save thousands of lives by demanding that state leaders expand close the Medicaid gap by accepting federal dollars to expand Medicaid coverage.

Here’s Dr. van der Horst:

“On Saturday, I am rising early with other health care workers and students to carpool and bus to Raleigh, where we’ll march once again down Jones Street for some old fashioned rabble-rousing.

Since the ACA started, 31 states and DC have expanded Medicaid. Ten states led by conservative Republicans, initially vehemently opposed to Medicaid expansion, have reversed course. In three states where Republicans subsequently won governorship, they elected to continue the expansion. Two Republican-led states are in discussion to expand.

These leaders came to their senses when they realized the benefits in savings, the jobs created, the federal dollars flowing to their states instead of away, and the help to their citizens. When that many Republican governors and legislatures have expanded Medicaid, it is difficult to understand why McCrory, Senate Pro Tem Phil Berger and Speaker of the House Tim Moore have ignored the economic and health benefits to the state.”

And here is the excellent conclusion:

“With two years of data available, the health benefits of expanding Medicaid are clear. In states that did not expand Medicaid, rural hospitals have been closing as they could no longer afford to provide free care. From 2010 to 2015, 57 rural hospitals closed, 42 of them – including three in North Carolina – in states that did not expand Medicaid. Rich or poor, it is nice to have a hospital close when your heart stops beating.

Medicaid expansion also allows for more preventive medicine. The governor and legislature have adopted the concept of penny wise, pound foolish. From blood pressure control to cholesterol and diabetes care, the cost of treatment for complications far exceeds that of prevention.

In April the legislature reconvenes. They should listen to the health care workers across the state and lift the block on Medicaid expansion.”

Commentary

Independents and Republicans in NC support closing the coverage gap

A new poll from the nonpartisan organization NC Child shows that a large majority of North Carolinians support closing the health insurance coverage gap that was created when the Governor and legislature declined to use available federal funds to expand Medicaid eligibility. This support extends to Independents and Republicans. The poll found that overall 72 percent of North Carolinians support closing the coverage gap. Among the Independents who often make the difference in close elections support is 62 percent. The same percentage of Republicans want to close the gap.

You can read the analysis from NC Child here.

We know that support or opposition to closing the coverage gap can depend on how you ask the question. This poll was a pretty straightforward description of the Medicaid gap and the policy option before the Governor and legislature. Here’s how the poll was worded:

In North Carolina, more than 350,000 adults, most of them working, cannot afford health insurance on the wages they are paid in industries like retail, construction, and food service. Their incomes are too low to qualify for the tax credits available through the Affordable Care Act and too high to qualify for Medicaid. They are stuck in the ‘insurance coverage gap.’ The Legislature and Governor McCrory could fix the coverage gap by creating a special North Carolina plan in partnership with the Federal government. Do you think North Carolina should make a plan to fix the health insurance coverage gap, or not?

We’ll have to see whether this changes the minds of political leaders. After elected officials in a number of conservative states saw similar polls and watched federal funds flow to other regions they decided to take action to protect their residents and boost rural health care. Let’s hope our politicians have a similar reaction.

Commentary, News

Wake Forest researchers: NC should close the Medicaid gap now

Medicaid expansionStill more experts have weighed in in favor of following the lead of dozens of other states and expanding Medicaid in North Carolina. A new report by a pair of Wake Forest University professors of health law says that North Carolina leaders are making a mistake by refusing to act. Click here to read “Medicaid Expansion Costs in North Carolina: A Frank Discussion.”

Here’s the conclusion:

“There is no denying that Medicaid expansion in North Carolina will have some costs. And, for those who distrust the federal government with a fiery passion, there may be nothing that can convince them to consider this major expansion of federal support. However, a more dispassionate examination of the issues greatly reduces well-founded concerns over expansion costs to the state.

Several expert studies have calculated what actual expansion costs would be, and what portion of those costs the state would actually bear. Expansion funding, like an iceberg, has both a visible tip, and a much larger hidden part below the surface. The tip of expansion costs, which are several billion dollars a year, is the 10 percent that the state would have to pay. The federal government pays the rest. That much larger, 90%-hidden part of the iceberg represents not a cost to the state, but instead money coming into the state.

This new federal funding melts throughout the state’s economy. The increased federal funds would create new well-paying jobs and boost economic activities that increase tax revenue without increasing tax rates. Expansion would also create savings for the state by reducing what it has to spend both on existing Medicaid recipients, and on other non-Medicaid programs like mental and substance abuse treatments and medical care for inmates. And, federal funds reduce what state and local governments currently pay for free care that now goes to low- income people who lack insurance. All told, these economic benefits and savings to state and local governments will approximately equal the extra costs to the state of expansion.

That math works as long as the federal government does not reduce what it will pay for North Carolina residents on Medicaid. Although the ACA has survived every one of the legal and political challenges it has faced, there is no guarantee that federal support will continue forever. However, it would be both illogical and extremely difficult for the federal government to back out of its deal with the states now. Even if some risk remains, states are not defenseless; they can take several steps to protect themselves, in the form of triggers, sunsets, or waivers.

The question, then, for the people and the leaders of North Carolina, is whether a small cost and a small risk are prices worth paying to provide insurance coverage to several hundred thousand people who cannot afford coverage on their own, even though the majority of them are working.”

Commentary

An early start to your New Year’s resolutions: Get health coverage

Enroll America

Image: www.enrollamerica.org

Despite policymakers’ attempts to repeal all or parts of the Affordable Care Act (ACA) nearly 60 times, the ACA works. What’s more, the law is clearly here to stay. On both occasions that all or specific provisions of the ACA have been to the Supreme Court, the health care law has remained largely intact. In 2014, the ACA enhanced the well-being of nearly 460,000 North Carolinians who were able to obtain affordable health care coverage.

Now, it’s time once again for the uninsured to enroll. Open Enrollment 3 started on November 1 and goes until January 31, 2016. As of December 5, nearly 200,000 people in North Carolina had applied for health care coverage through the Marketplace. Today, December 15, is the deadline to enroll for health coverage starting on January 1, 2016.

Even though there has been much attention paid to increasing premiums for coverage purchased through the Marketplace, many North Carolinians will still receive financial help. The average amount of financial assistance received by ACA enrollees is $315 per month. Further, the majority of enrollees selected plans costing less than $75 per month.

Another fiscal consideration is that the penalty for not enrolling in a plan is increasing to $695 per person or 2.5 percent of one’s household income, whichever is higher. 2016 will also be the first year that people will not receive an additional grace period or special enrollment period around the tax deadline. Even though the financial impact of obtaining health coverage is significant for many households and individuals, having access to health care gives one peace of mind. The ACA mandates the coverage of essential health benefits ranging from maternity and newborn care to mental health and substance use disorder treatment.

Unfortunately, hundreds of thousands of North Carolinians will not qualify for health coverage through the ACA, do not have access to employer based health insurance, and are ineligible for Medicaid. Our state policymakers have failed to extend health coverage through Medicaid expansion to home health care workers, parents, office clerks, and school bus drivers.

One year ago, the Cone Health Foundation released a report highlighting the benefits of Medicaid expansion. If our state legislators would have chosen to expand Medicaid, 29,000 jobs would have been created this year. In addition to the approximately 200,000 (and counting) North Carolinians who will have health coverage starting in the new year by enrolling in the ACA, according to the report 300,000 people would have gained health coverage if policymakers had decided to expand Medicaid this year. Let’s start 2016 on a healthy note, enroll for health coverage today and encourage your state policymakers to expand Medicaid to 500,000 North Carolinians in the coverage gap.