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Nicole and LindaTomorrow is Women’s Advocacy Day at the North Carolina General Assembly and there are a lot of good reasons for caring women (and men) to attend. The one at the top of my list will be Medicaid expansion – the long-neglected plan to extend decent, affordable health coverage to hundreds of thousands of North Carolinians.

As has been explained repeatedly in countless places in recent months, North Carolina would benefit greatly from Medicaid expansion. The numbers of lives that would be saved and the amount of money that would flow to the state are both huge and more than reason enough for state leaders to act. As a group that has long endured lower pay and benefits, women would also benefit disproportionately from expansion.

For me, however, the motivation for speaking out goes well beyond the numbers. It’s also about speaking out on behalf of people who I know and care about – people like my friend, Linda Dunn (that’s us on the left at the General Assembly last month).

I met Linda back in December at a community forum in Kinston at which Sen. Don Davis, Lenoir County Sheriff Ronnie Ingram and several other community leaders expressed concern about the failure to expand Medicaid and the fact that, in Lenoir County alone, expansion would cover 2,270 residents and create more than 350 desperately needed jobs.

Linda attended the forum along with her adult daughter. I met them just before the discussion was set to begin. She was terribly concerned about her daughter’s lack of access to insurance and medical care.

In fact, she was so concerned that she was later inspired to travel to Raleigh to share her family’s story during last month’s Medicaid Expansion Advocacy Day. Linda held onto the podium in the Legislative Building press room while some in the audience held back tears as she spoke like only a mother could about the devastating impacts of suffering from chronic health conditions without insurance. Read More

Poverty and Policy Matters

There are few situations in life that are clearly win-win. When you see one, you have to take advantage of it.

That’s why North Carolina should reverse course and expand Medicaid. When you have the chance to improve health care for hundreds of thousands of people and actually save money, you should jump on it.

In a recent News & Observer editorial, the paper called the decision not to expand Medicaid “wildly irresponsible and hugely expensive.” That’s precisely correct, and let’s explore the first part of the statement a bit more.

Turning down Medicaid expansion turns down $50 billion in federal funding and prevents roughly 400,000 of our neighbors from getting covered. That makes expanding Medicaid an obvious choice.

But also consider that preventative care saves money over the long run. Insuring people means they get to go to the doctor, which means we pay less to prevent disease. This leads to lower costs for taxpayers and better lives for our people. An excerpt from the N&O piece:

Community Care said in a news release: “The medical costs for low-birth-weight babies average $49,000 in a baby’s first year of life, or more than 10 times more than babies born without complications. A low birth weight also increases a child’s risk for long-term medical and developmental complications and the likelihood of incurring additional expenses for social services and educational needs in later years.”

Kate Berrien, manager of Community Care’s pregnancy project, said North Carolina now leads the South in having the fewest births before 39 weeks. That’s a lot of savings and a vast increase in the quality of life for many children born to low-income mothers. And it’s an achievement attributable to innovations in community-level care that were developed in North Carolina and are being adopted across the nation.

It’s a win-win situation. Tom Wroth, CCNC’s chief medical officer, said, “We’ve been able to align improving clinical quality with lower cost.”

Read that last paragraph again. Improving quality care with lower cost is a win-win. So is expanding Medicaid.

News

An annual audit of North Carolina’s compliance with federal human services programs uncovered significant issues at the state’s health agency, including overpaying for Medicaid services and skipping a background check for adoptive parents.

The audit released on March 31 found problems with nearly every program they checked at the N.C. Department of Health and Human Services, from administration of the federal food stamps program to Medicaid billing and neglecting to spend a federal grant to help AIDS and HIV patients.

DHHSA DHHS spokeswoman said the agency has worked under in recent years under Secretary Aldona Wos to improve the management of federal programs, and plans on addressing the issues highlighted in the audit.

“The department has made significant progress improving its operations over the past two years and we continue to value the role that audits can play in further enabling us to do so,” DHHS spokeswoman Alex Lefebvre wrote in an emailed response to questions. “This annual audit will be used by the department to continue on the path of improved effectiveness.”

There were other findings that didn’t point to wasted money, but may have put children’s safety at risk.

The N.C. Department of Health and Human Services didn’t check to make sure prospective adoptive parents were clear of prior abuse allegations, by checking a registry of abuse and neglect allegations.

“The Department did not monitor that the child abuse registry was checked before a child was placed for adoption,” the federal compliance audit stated. “As a result, children could be placed in an unsafe environment.”

DHHS, in the response contained in the audit, said it thought county-level officials had ensured the abuse and neglect check had been done. Criminal background checks were conducted.

Read More

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.