Commentary

Physician from NC Senate leader’s district makes impassioned plea for Medicaid expansion

deny-medicaid-400x270In case you missed it, a veteran family physician from Senate President Pro Tem Phil Berger’s home county of Rockingham has authored one of the best new pleas for closing North Carolina’s Medicaid gap that currently keeps hundreds of thousands of working North Carolinians uninsured. In an open letter to Berger and Gov. Pat McCrory in the Greensboro News & Record, Dr. Stephen Luking offers several heartrending examples from his own practice about good, honest people whose health and life expectancy have been directly endangered as a result of the state’s stubborn resistance to Medicaid expansion. As he notes:

“These families aren’t ‘takers’ looking for a handout. The working poor are our cousins and our neighbors. They sit with us in the pews on Sunday; their children or grandchildren go to school with ours.

Some have watched well-paying jobs fly to Mexico or China. Some through personal or family circumstance earn meager wages. Some have employers who craftily maintain them under “temp” status or keep their hours worked under 30 hours per week to avoid insurance obligations. Some have reached their God-given potential.

Who are we to pass judgment? The fact is that near-poverty has left all of them uninsurable without Medicaid. Your rejection of Medicaid expansion may have earned you bona fides and high-fives in political circles, but in the real world your decision has harmed these families left and right.”

And here’s the powerful conclusion:

“Like any family doctor who has practiced for 30 years, I know what it’s like to make a decision that leads to the death of a patient. The appropriate intervention gone badly, the symptom after consideration mistakenly reassured. … I can tell you, it cuts like a knife. You face the family and fight back the tears. You wake up in the middle of the night in a cold sweat and wish you had that moment back.

And sometimes one night leads to a dozen. My wife will tell you, it’s a load to carry.

Gov. McCrory and Sen. Berger, you now carry that same weight, whether you will admit it or not. Welcome to this our unfortunate fraternity: those who carry the blood of others on our hands. Like it or not, we are all three members.

Some in Rockingham County will surely die — if some haven’t already — because of your partisan decision to reject Medicaid expansion.

Please embrace our shared humanity. The two of you have the power to get this done.

Re-approach this issue with an open mind and you will experience a change of heart.

Until then, I hope you’ll wake up some nights in a cold sweat, knowing you have committed a terrible wrong. Shame on you for your complicity thus far in denying basic health insurance to the most vulnerable residents of our state.

Shame on the rest of us for letting you get away with it.”

 

NC Budget and Tax Center

New report shows where NC economic policy is out of whack

A report out today highlights a lot of areas where North Carolina’s economic policy is badly wanting. Drawing on a trove of economic analysis, the report identifies common-sense policies that can grow an economy that works for everyone.Greatest-Hits-Social-Final_FPA-All (002)

Let’s just say that North Carolina has plenty of room for improvement. As legislators gear up for the 2016 session, here are a few ways we could move toward a more inclusive and competitive economic footing:

The report identifies a number of other areas where North Carolina’s recent policy choices are out of step with common sense and solid evidence, but these are some of the most glaring examples.

The good news is that we can do better. North Carolina is not doomed to witness the death of the middle-class, or to see poverty become an inter-generational destiny, or to watch helplessly as working North Carolinians miss out of the fruits of economic growth. We can build an economy that works for everyone, it just takes the political will to make it happen.

Commentary

Editorial: McCrory out of excuses on Medicaid expansion

There is plenty of room for argument as to whether the state Medicaid system was ever “broken” as claimed by some and why expenditures are now down, but there is one thing this development says for certain: Gov. Pat McCrory is out of excuses for not expanding the program to cover hundreds of thousands of the uninsured.

This morning’s lead editorial in the Fayetteville Observer explains:

[U]nlike some of his GOP brethren in the General Assembly, Gov. Pat McCrory wasn’t an ideologue about [Medicaid expansion]. It was clear that he saw the benefits of an expansion, which mostly would be funded by Washington. Without it, hospitals would face greater financial pressures, and the ‘working poor’ would continue to show up at emergency rooms for medical care because they still couldn’t afford health insurance.

McCrory took a pragmatic approach. Medicaid in North Carolina, he said, was a ‘mess’; it was ‘broken.’ It was all of that, with annual cost overruns in the hundreds of millions. It was hard to justify expanding a broken system and growing those deficits any further.

But the system isn’t broken anymore. It’s under control. As of the end of December, the governor announced in a press release last month, Medicaid was $181 million under budget. Yes, under budget by the same kind of numbers that it once exceeded its budget….

With that accomplished, McCrory’s only good objection to Medicaid expansion is gone. So are his precedents: many of his fellow Republican governors. That includes Ohio Gov. John Kasich, one of the last GOP presidential candidates still standing. Kasich, a pragmatist, ran the numbers and saw Medicaid expansion creating new jobs, keeping hospitals afloat and, of course, making people in his state healthier.

He took advantage of federal flexibility and designed a Medicaid program that fit his and his party’s conservative principles.

It’s time to do that here. Medicaid expansion will save lives and improve many more. It will save endangered hospitals from shutting down. And it will create thousands of new jobs in the health care industry.”

Commentary

Independents and Republicans in NC support closing the coverage gap

A new poll from the nonpartisan organization NC Child shows that a large majority of North Carolinians support closing the health insurance coverage gap that was created when the Governor and legislature declined to use available federal funds to expand Medicaid eligibility. This support extends to Independents and Republicans. The poll found that overall 72 percent of North Carolinians support closing the coverage gap. Among the Independents who often make the difference in close elections support is 62 percent. The same percentage of Republicans want to close the gap.

You can read the analysis from NC Child here.

We know that support or opposition to closing the coverage gap can depend on how you ask the question. This poll was a pretty straightforward description of the Medicaid gap and the policy option before the Governor and legislature. Here’s how the poll was worded:

In North Carolina, more than 350,000 adults, most of them working, cannot afford health insurance on the wages they are paid in industries like retail, construction, and food service. Their incomes are too low to qualify for the tax credits available through the Affordable Care Act and too high to qualify for Medicaid. They are stuck in the ‘insurance coverage gap.’ The Legislature and Governor McCrory could fix the coverage gap by creating a special North Carolina plan in partnership with the Federal government. Do you think North Carolina should make a plan to fix the health insurance coverage gap, or not?

We’ll have to see whether this changes the minds of political leaders. After elected officials in a number of conservative states saw similar polls and watched federal funds flow to other regions they decided to take action to protect their residents and boost rural health care. Let’s hope our politicians have a similar reaction.

Commentary, News

Wake Forest researchers: NC should close the Medicaid gap now

Medicaid expansionStill more experts have weighed in in favor of following the lead of dozens of other states and expanding Medicaid in North Carolina. A new report by a pair of Wake Forest University professors of health law says that North Carolina leaders are making a mistake by refusing to act. Click here to read “Medicaid Expansion Costs in North Carolina: A Frank Discussion.”

Here’s the conclusion:

“There is no denying that Medicaid expansion in North Carolina will have some costs. And, for those who distrust the federal government with a fiery passion, there may be nothing that can convince them to consider this major expansion of federal support. However, a more dispassionate examination of the issues greatly reduces well-founded concerns over expansion costs to the state.

Several expert studies have calculated what actual expansion costs would be, and what portion of those costs the state would actually bear. Expansion funding, like an iceberg, has both a visible tip, and a much larger hidden part below the surface. The tip of expansion costs, which are several billion dollars a year, is the 10 percent that the state would have to pay. The federal government pays the rest. That much larger, 90%-hidden part of the iceberg represents not a cost to the state, but instead money coming into the state.

This new federal funding melts throughout the state’s economy. The increased federal funds would create new well-paying jobs and boost economic activities that increase tax revenue without increasing tax rates. Expansion would also create savings for the state by reducing what it has to spend both on existing Medicaid recipients, and on other non-Medicaid programs like mental and substance abuse treatments and medical care for inmates. And, federal funds reduce what state and local governments currently pay for free care that now goes to low- income people who lack insurance. All told, these economic benefits and savings to state and local governments will approximately equal the extra costs to the state of expansion.

That math works as long as the federal government does not reduce what it will pay for North Carolina residents on Medicaid. Although the ACA has survived every one of the legal and political challenges it has faced, there is no guarantee that federal support will continue forever. However, it would be both illogical and extremely difficult for the federal government to back out of its deal with the states now. Even if some risk remains, states are not defenseless; they can take several steps to protect themselves, in the form of triggers, sunsets, or waivers.

The question, then, for the people and the leaders of North Carolina, is whether a small cost and a small risk are prices worth paying to provide insurance coverage to several hundred thousand people who cannot afford coverage on their own, even though the majority of them are working.”