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Earlier this week, health care advocates across the nation marked a milestone: the 50th anniversary of the Medicaid and Medicare programs.

To mark the occasion, the good folks at North Carolina Health News have put together a useful interactive map, demonstrating how Medicaid benefits the residents of each county in our state.

Here’s a snapshot of how the program benefits Rockingham County, the home county of Senate President Phil Berger:

nchealthnewsmapClick here (and scroll down) to view the full map and read more about how Medicaid provides lifesaving health care to the most vulnerable people in North Carolina.

This weekend, NC Policy Watch will discuss Medicaid expansion on its weekly radio show, News & Views with Chris Fitzsimon.

Joining Chris will be Joan Alker, the executive director of Georgetown University’s Center for Children and Families.

Alker discusses CCF’s new report on how parents and kids benefit from closing North Carolina’s Medicaid coverage gap.  (CCF recently traveled to North Carolina to release the report in partnership with NC Child and the NC Health Access Coalition.)

Below Alker talks about why Governor Pat McCrory is overdue in presenting  a state-specific plan for Medicaid expansion:

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News

Robeson County officials settled a complaint with the federal justice department this week, saying it would take steps to improve access for disabled residents to public resources.

The federal agency had found the county had numerous violations of the Americans with Disabilities Act (which was passed 25 years ago) , leaving those with disabilities unable to access county services and programs as easily as other citizens.

A news release from the U.S. Justice Department about the settlement noted that Robeson County, on North Carolina’s border with South Carolina, has a poverty rate of over 30 percent, and nearly 40 percent of its population identities as Native American, and 25 percent are African-American.

According to the settlement, the county agreed to make changes to buildings and county property so that parking, building entrances, restrooms, service counters and drinking fountains can be accessed by those with physical disabilities. The sheriff’s office will also have to devise a plan so that its deputies and emergency responders can communicate with those who are deaf or hard-of-hearing, and accommodations will be made at voting sites so that those that use wheelchairs or who are blind or with vision issues can cast votes without hindrances.

The settlement comes the same week the N.C. Auditor’s Office released an audit that found the public school system in Robeson County misused $3 million in Medicaid funds meant for children with special needs.

From an Associated Press article about the audit:

The audit issued Monday says for three fiscal years starting in 2011, the school system did not use about $1 million per year in Medicaid reimbursements to provide services for special-needs students as required.

The school system said in a letter to the auditor’s office that it wasn’t told by state education officials that the money was required to be used for special-needs students. It acknowledges that reimbursement money went to other district needs.

State schools Superintendent June Atkinson said in a letter that education officials will work with Robeson County and districts statewide on how the reimbursements are used.

Click here to read the entire audit.

Robeson County officials settled a complaint with the federal justice department this week, saying it would take steps to improve access for disabled residents to public resources.

The federal agency had found the county had numerous violations of the Americans with Disabilities Act (which was passed 25 years ago) , leaving those with disabilities unable to access county services and programs as easily as other citizens.

A news release from the U.S. Justice Department about the settlement noted that Robeson County, on North Carolina’s border with South Carolina, has a poverty rate of over 30 percent, and nearly 40 percent of its population identities as Native American, and 25 percent is African-American.

According to the settlement, the county agreed to make changes to buildings and county property so that parking, building entrances, restrooms, service counters and drinking fountains can be accessed by those with physical disabilities. The sheriff’s office will also have to devise a plan so that its deputies and emergency responders can communicate with those who are deaf or hard-of-hearing, and accommodations will be made at voting sites so that those that use wheelchairs or who are blind or with vision issues can cast votes without hindrances.

The settlement comes the same week the N.C. Auditor’s Office released an audit that found the public school system in Robeson County misused $3 million in Medicaid funds meant for children with special needs.

From an Associated Press article about the audit:

The audit issued Monday says for three fiscal years starting in 2011, the school system did not use about $1 million per year in Medicaid reimbursements to provide services for special-needs students as required.

The school system said in a letter to the auditor’s office that it wasn’t told by state education officials that the money was required to be used for special-needs students. It acknowledges that reimbursement money went to other district needs.

State schools Superintendent June Atkinson said in a letter that education officials will work with Robeson County and districts statewide on how the reimbursements are used.

Click here to read the entire audit.

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

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.