Archives

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.

Commentary

The beneficial impacts of Obamacare continue add up, but unfortunately, North Carolina isn’t getting its fair share. That’s that’s one of the takeaways from a new report distributed yesterday on the fifth anniversary of the law. As health policy expert Tara Culp Ressler of Think Progress reports:

“According to a new report from the Department of Health and Human Services (HHS), hospitals saved at least $7.4 billion last year, thanks in large part to reforms under Obamacare. The savings reflect a reduction in the so-called “uncompensated care” that hospitals provide to uninsured Americans, and are even greater than HHS officials predicted they would be at the beginning of this year.

Since people without insurance typically don’t have any means to cover their medical bills, the cost of their treatment ends up falling on the hospital itself. Therefore, as more people gain coverage, it become less expensive for hospitals to care for their patients. More than 16 million previously uninsured Americans have gotten covered under Obamacare, contributing to the biggest drop in the national uninsurance rate over the past four decades.”

If states like North Carolina had gotten on board with closing the Medicaid gap, things would be even better:

“The savings have been most pronounced in the states that agreed to accept Obamacare’s optional Medicaid expansion, which seeks to extend public insurance to additional low-income people. Nearly 70 percent of the savings documented in the HHS report — a total of $5 billion — occurred in the 29 states that have expanded Medicaid. And, if every state had agreed to add more people to their Medicaid rolls, their hospitals could have saved an extra $1.4 billion.”

In other words, here’s more confirmation that,  in addition to helping hundreds of thousands of working people in need, Medicaid expansion would do wonders for some of the most important businesses in North Carolina (especially in rural North Carolina) hospitals. It’s hard to imagine that state leaders can resist taking this obvious and long overdue step much longer.

Commentary

Out-of-state activist J. Scott Moody will be making the rounds on Monday in North Carolina to say that expanding Medicaid will hurt our economy.

Moody is from a South Carolina outfit called State Budget Solutions and he travels the country speaking out against policies disfavored by conservatives. His schtick is releasing cut-and-paste reports showing the economic harm done by the programs he opposes.

For example, in 2012 he lit off to New Hampshire to warn that allowing same sex marriage in that state would result in economic devastation and a “demographic winter.” You have to read the entire news article of his visit to capture his arguments in all of their glory, but this is one of my favorite parts:

Also, according to Moody, when same-sex couples adopt, they place the child in a situation where one or both of their parents isn’t their biological parent. However, according to Moody, statistics have shown that a relationship with a stepparent is not the same as a relationship with a biological parent and stepparents tend to not have the same bond or pay the same attention as the biological parent. Moody did not provide charts or actual sources for this claim.

These days Moody is taking a break from attacking adoptive parents and is focusing on Medicaid expansion. Moody has made presentations in several states and published opinion pieces arguing that an expansion of the public sector will crowd out private sector spending. This analysis is about as sophisticated as his arguments that gay marriage will destroy the economy and that stepparents don’t pay attention to their children.

Actual economists have responded to Moody everywhere he has spoken to point out that he is wrong. A good example is from Dr. Sven Wilson at BYU when Moody visited Utah to warn them of the dangers of federal funds flowing to the state. Again, you should read the entire piece but here’s a taste of Wilson’s response:

Many economists argue that spending on Healthy Utah will further expand the economy by generating new jobs and new private spending as the money works its way through the economy. Economists call this effect a multiplier. As a conservative, free-market economist, I think multipliers are generally small. But no serious economist of any political stripe thinks the multiplier is negative, which is what Moody is suggesting.

Imagine someone saying that when tourists spend their money in our state, their purchases end up costing us jobs and hurting our economy. Who would believe that? But that is exactly the argument Moody is making about Healthy Utah.

Luckily, we already have a study on the economic impacts of Medicaid expansion in North Carolina using respected REMI models. That study concludes that expansion will grow our economy, create 43,000 jobs, and provide much needed revenue to county and state budgets. It will also provide affordable coverage to 500,000 North Carolinians and bolster rural health care in the state. States that have already expanded coverage, like Kentucky, are seeing these positive economic predictions realized.

We aren’t seeing the winter Moody predicted in 2012. Instead the economy keeps heating up despite gay marriage sweeping the nation. I suspect we will see similar results as more states expand insurance coverage.