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well-timed tissueGov. McCrory may have shed a few tears yesterday over the departure of his Secretary of Health and Human Services, Aldona Wos, but the chief reaction across the state — both within government and without — was relief and a strong feeling of “what took so you long? This morning’s editorial pages tell the story:

Here’s Wos’ hometown Greensboro News & Record in an editorial called “Good heart, bad fit”:

“As for tangible results, well, that was another matter. Despite her background as a physician and former U.S. ambassador— and her famous, sunrise-to-late-night work ethic — the sheer weight of the DHHS bureaucracy seemed to overwhelm Wos.

In time, critics on both sides of the partisan aisle began to wonder out loud if they were getting their money’s worth.

Now, after two and half years at the post, Wos is leaving, Gov. Pat McCrory announced at a Wednesday news conference in Raleigh. Standing at his side, Wos noted it was ‘time to go home.’ Although the governor tearfully praised Wos’ job performance and commitment — as he has all along — her tenure has been wracked by a series of missteps and crises, large and small…”

The N&R then goes on to list a half dozen HHS disasters under Wos’ leadership.

Raleigh’s N&O put it this way in a piece entitled “Don’t cry for me North Carolina”:

“Some Republican lawmakers were annoyed by the turmoil in the department and Wos’ inability to provide reliable numbers on the cost of Medicaid. Senate Republicans even proposed that their version of Medicaid reform would remove the program entirely from DHHS and place its management under the control of a new agency. Indeed, lawmakers doubts about Wos may well have played a role in her resignation.”

The Winston-Salem Journal called for the department to be put back on track:

“The resignation Wednesday of Dr. Aldona Wos, the embattled secretary of the state Department of Health and Human Services, was as overdue as it was unsurprising.…During the two-and-a-half years she has served as secretary, legislators of both parties, advocates and state audits have repeatedly pointed out flaws in the department’s delivery of service to some of our most vulnerable citizens.”

Charlotte Observer cartoonist Kevin Siers compares the department Wos leaves behind to the Statue of Liberty — the torch section.

Meanwhile, the Fayeteville Observer took a different approach, noting that Wos’ departure provides a perfect time to expand Medicaid:

“When he explained why he declined to adopt Obamacare’s expanded Medicaid coverage two years ago, Gov. Pat McCrory said he couldn’t do it because the system was broken. Two consecutive years into positive fund balances, it doesn’t look broken anymore, does it? Where, then, is the expansion initiative, which would bring billions of federal dollars to North Carolina, insure hundreds of thousands of residents without coverage and likely save some rural hospitals from shutting down?”

Commentary

Medicaid expansionFor years now, poor and working North Carolinians who would benefit greatly from Medicaid expansion under the Affordable Care Act have been held hostage as Governor McCrory procrastinated and offered excuses. First, the Guv claimed that the Medicaid system itself was “broken” and in need of repair before it could be expanded. Then, he claimed that it would be inappropriate to act until the U.S. Supreme Court ruled on the constitutionality of the ACA itself.

Today, McCrory is running out of excuses. The Supreme Court took care of the constitutionality question a few weeks ago and yesterday, McCrory himself laid Excuse #1 to rest.

According to a statement from the Governor’s office, Medicaid is now in the black:

“The Department of Health and Human Services reported today that the North Carolina Medicaid program ended the 2014-15 state fiscal year with $130.7 million cash on hand. This is the second consecutive year the Medicaid program has finished with cash on hand.”

What’s more, that surplus is more than enough to cover state costs of implementing expansion. As a December 2014 study from health policy wonks at the Milken Institute School of Public Health at George Washington University reported (see page 15), expansion will actually save the state more than $300 million over the next five years. In 2020, however, there will be a modest net cost to the state of $91.7 million.

The obvious takeaway? Even if the state flushed away the savings that expansion will bring between now and 2020, it can easily cover the modest bump in costs in 2020 merely by socking away the current surplus.

Not surprisingly, however, the Guv is already moving the goalposts. Read More

Commentary

After reading this fact sheet from the American Public Health Association (APHA), it is apparent that NC policymakers need to take action in order to improve our state’s public health. If our state legislators were assigned a grade for how they are investing in NC’s public health, it would not be a passing grade. The following statistics show there is much room for improving NC’s public health rankings:

  • Ranks 8th for prevalence of diabetes amongst adults.
  • Ranks 47th for the availability of dentists.
  • Ranks 10th for infant mortality.
  • Ranks 47th for the amount invested in each person’s public health needs. NC spends $11.73 per year per resident.
  • Ranks 5th for the number of children living in poverty.

While these numbers are unimpressive at best, there are some public health areas that NC has improved on. First, the high school graduation rate has improved, but then again the Senate budget proposes tax cuts that lower the number of teacher assistants, which could negate the progress made. Second, NC has made great progress in reducing air pollution, but then again the House wants to cut auto emissions tests in some counties.

Even though the sequester led to significant cuts in public health funding, there is federal funding available to address the poor rankings listed above. NC could receive funding to help the following:

Fifteen percent of North Carolinians are uninsured and 500,000 people are in the Medicaid coverage gap. These are people that could seek primary preventative health care that will yield better health outcomes such as prenatal and maternity care to ensure healthy outcomes after childbirth. Research has shown that children eligible for Medicaid miss fewer school days, have higher educational attainment. and their families have more financial security. There are also 150,000 people in NC in the coverage gap with mental health and substance use disorders that need ongoing treatment. The Affordable Care Act has written into law that the federal government will cover 100% of Medicaid expansion costs until 2016 and up to 90 percent of costs starting 2020. Ensuring coverage to one half million North Carolinians is one public health act that will pull NC up the rankings.

Commentary

As Adam Linker noted yesterday in the post below, there are no more excuses now for Gov. McCrory:

“Now that the Supreme Court has ruled — again — that the structure of the Affordable Care Act is constitutional, it is time to move forward with making the law work better in our state.

The first, and most important, step is accepting federal funds to extend the benefits of affordable health insurance coverage to 500,000 more people in our state. Gov. McCrory said last year that his staff was assembling options to expand coverage and that he would make an announcement about his recommendation after the Supreme Court ruled in King v. Burwell. The ruling has arrived.”

This morning, major newspapers around the state are echoing this sentiment.

From the Durham Herald-Sun:

“With the question of the act’s validity answered by the court, it’s time for North Carolina
to reverse its unfortunate decision to not extend Medicaid coverage to an estimated
500,000 individuals and families too poor to qualify for the ACA subsidies.”

From the Greensboro News & Record:

“This was an enormous victory for President Obama. Most importantly, it avoids the human toll that would have resulted from an adverse ruling.

Next, North Carolina should expand Medicaid coverage for thousands of residents who still fall between the coverage cracks. State leaders should have expanded Medicaid in the first place, but seemed more intent on thumbing their noses at the president than doing what’s right. Not only is most of its cost paid for by the federal government, but also it would create as many as many as 43,000 jobs. Gov. Pat McCrory had said he wanted to wait for the Affordable Care decision first before considering that step. Now that the high court has ruled, it’s time for him to act.”

From Raleigh’s News & Observer:

“Meanwhile, Gov. Pat McCrory has shown a lack of political courage in declining to support an expansion of Medicaid, the state and federal insurance program for the poor and disabled. The federal government, under the Affordable Care Act, would pay 100 percent of the expense in the first three years and at least 90 percent thereafter. McCrory said he was awaiting the high court decision to make his own decision about pushing for Medicaid expansion. But he wasn’t. Once again, the 500,000 North Carolinians who could be helped are left to hope that a move to expand Medicaid comes before an illness or an accident does.”

In other words, come on Governor, get off your keister do the right thing!
Commentary

While many of us are anxiously waiting for the Supreme Court decision on King v. Burwell, a recent poll shows that 44-percent of people still don’t know much about the case.

The King v. Burwell ruling will determine the legality of health insurance subsidies for states using the federal marketplace. If the Supreme Court rules against the Affordable Care Act (ACA) and decides that health insurance subsidies for the 34 states that do not have a state marketplace are “illegal,” more than six million people across the U.S. may lose their ability to access affordable health care. Since they live in one of the states that rely on the federal marketplace, 458,738 North Carolinians could lose their health coverage. Nationally, the average subsidy (or advance tax credit) amount is $272 per month and in North Carolina, people receive $316 per month.

Considering that subsidies could become unavailable as early as September 2015 and that North Carolina has failed to expand Medicaid, the number of uninsured could increase to nearly one-million people. Sylvia Burwell, the Secretary of Health and Human Services, has stated that if there is a negative outcome from the Supreme Court decision on King v. Burwell, the U.S. Congress and state policymakers will have to decide on how to keep access to health coverage affordable.

As data continue to show that the ACA is working to increase access to care – for example, the rate of uninsured women has decreased nearly eight percent since 2013 and 12.2 million adults have access to health care in the 30 states (including DC) that have expanded Medicaid – state lawmakers and Congress may be feeling even more pressure to keep subsidies. Even the Congressional Budget Office has reported that gutting the ACA would increase the deficit by $137 billion by 2025. Despite the potential economic impact, media reports continue to highlight the fact that conservative policymakers in Washington D.C. do not have a better alternative to the ACA. Further, one “fix” proposed by Sen. Ron Johnson of Wisconsin would only extend subsidies for current ACA enrollees until 2017.

If the outcome of King v. Burwell isn’t positive, let’s hope that our state and national policymakers work to keep 6.4 million people insured. No matter how the Supreme Court rules, let’s hope that our state policymakers will take on the next challenge – extending access to affordable health care to 500,000 North Carolinians in the coverage gap as Medicaid expansion makes economic and moral sense.