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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

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.

When asked about expansion today McCrory was sort of squishy and said he wants a North Carolina plan. We all do. But first we need the Governor to draft and release such a plan. Conservative Governors in Ohio, Indiana, Utah, Michigan, Tennessee and other states have either closed the coverage gap or assembled a strategy to accomplish a coverage expansion. There’s no reason our Governor can’t do the same.

Legislators are still critical of expansion. Sen. Ralph Hise says that he doesn’t think the federal government will be flexible enough to allow a state option. His wish list includes wanting to expand using private insurance and imposing co-pays on recipients above the federal poverty level.

Of course, the federal government has approved even more conservative measures than Hise mentions. Several states including Arkansas, Iowa, and Michigan do use private insurance to expand coverage. Some states are charging co-pays and premiums even on enrollees earning less than the federal poverty level. The federal government has shown a degree of flexibility that makes many advocates uncomfortable. The idea that our hands are tied is, to quote Justice Scalia, pure applesauce.

Recently released data from the National Health Interview Survey show the dramatic impact of expanding coverage. In Kentucky the adult uninsured rate dropped from 24.1 percent in 2013 to 15.6 percent in 2014. In Arkansas the rate went from 27.5 percent to 15.6 percent. And, most stunningly, in West Virginia the adult uninsured rate went from 28.8 percent in 2013 to 12.2 percent in 2014. These numbers reflect only the first year of expansion and states nearly cut their adult uninsured rates in half. In North Carolina the adult uninsured rate moved from 25.6 percent to 22.5 percent.

A majority of states are expanding coverage while reforming their Medicaid programs. More states will join their ranks now the Supreme Court has ruled that the Affordable Care Act is here to stay. The Governor must show leadership on this issue and ensure that all of our citizens have access to comprehensive, affordable health insurance.

News

Senate leaders included a surprise in Monday’s budget roll-out – their vision for Medicaid reform.

Sen. Ralph Hise detailed plans that would move Medicaid away from the state Department of Health and Human Services and to a newly created Health Benefits Authority.

The HBA, according to Hise, would contract with three healthcare providers to administer the $14 Billion program.

The new authority would not be subject to the state personnel act, allowing the new entity to set higher salaries for its employees.

Union County Senator Tommy Tucker says this new scenario would allow for greater flexibility, allowing the HBA to more immediately address cost overruns that have plagued lawmakers in the past.

But the change would also see DHHS Medicaid workers lose their positions after this new program is up and running in 2017. Tucker says the changes they are proposing would require a different skill set.

To hear a portion of Monday’s discussion on the proposed Health Benefits Authority, click below. You can also read more about the proposed changes on WRAL.com and NC Health News. Want more? You’ll find the full Senate budget here.

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Commentary

McCrory_budget305-aIt has been a rough couple of weeks for Governor Pat McCrory. First, the House and Senate overrode his vetoes of the so-called ag-gag bill and the legislation that allows magistrates to refuse to marry gay couples if they have a religious objection to marriage equality.

Then Monday Senate leaders rolled out a budget that refuses to restore the state historic tax credit program that McCrory has spent months promoting across the state. The budget also includes a plan to change how local sales tax revenue is distributed that McCrory vigorously opposes, and a proposal to reform Medicaid that McCrory’s appointees at DHHS don’t support.

And to add insult to injury, Senate President Pro Tem Phil Berger told reporters that he does not see the need for a transportation bond issue—another top McCrory priority—preferring instead to stop budget transfers out of the highway fund to raise money for highway projects.

It is the latest reminder that the folks running the Senate believe they are in charge in North Carolina regardless of what the governor of their own party believes.

Commentary

In 2013 the North Carolina General Assembly rejected new federal funds to expand health insurance coverage in the state, but that hasn’t stopped local governments from urging the Governor and legislators to change course.

Counties such as Mecklenburg and Durham have passed Medicaid expansion resolutions as have cities like Greensboro and Winston-Salem. Even Sen. Phil Berger’s hometown of Eden officially went on record endorsing expansion. The Rockingham County towns of Reidsville and Madison have since joined Eden.

This month three more counties — Nash, Edgecombe, and Chatham — joined the chorus.

As retired cardiologist Jim Foster pointed out to the Chatham Commissioners there are tremendous economic benefits to accepting more federal Medicaid dollars. From news coverage of the resolution:

“Anytime money flows into the economy, it ripples through and multiplies,” Foster said.

He pointed to a George Washington University study that broke down the costs and revenues from expanding Medicaid.

The study broke figures down for the state and for its 100 counties.

In Chatham, for example, the study stated that not expanding Medicaid cost 136 jobs and $6 million in gross product.e study Dr. Foster mentions can be found here.

Approval of the Nash County resolution was unanimous and Commissioners added a call for simultaneous reforms to Medicaid. This makes sense. In fact, nearly every expansion state is also reforming the program at the same time.

There is no reason North Carolina’s leaders can’t learn to walk and chew gum like most other states in the country.