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fact sheet scr shotToday the NC Justice Center released a new fact sheet titled “North Carolina’s Medicaid Choice: Options and Implications.”  The fact sheet gives a brief overview of the current national picture on state Medicaid expansion decisions to use federal money available under the Affordable Care Act.  It also gives more detail about who is in this coverage gap in NC and how other states – even states with very conservative leadership – are moving forward to improve coverage and care.

 

The math is done and it shouldn’t be a surprise to anyone – NC is losing $4.9 million per day since January 1, 2014 because Governor McCrory and the NC General Assembly refused to expand Medicaid.  This is money  NC taxpayers paid in federal taxes that is now headed to states like Arizona, New York, Arkansas and Nevada where conservative legislators and governors chose to expand coverage for their poorest citizens.  You can embed the counter below on your own page by going here.

(Estimate based on data from the NC Institute of Medicine for 2014-15.)

NC HHS Sec. Aldona Wos

NC HHS Sec. Aldona Wos

Yesterday, Governor Pat McCrory’s DHHS Secretary, Aldona Wos, unveiled the administration’s long-awaited reform plan for Medicaid.  One of McCrory’s favorite talking points on Medicaid has been how “broken” the system is and how he’s going to “fix” it.  Setting aside the past year of missteps in which McCrory and Wos did more than any Governor and Secretary in history to discredit and cause problems for NC’s award-winning Medicaid program, what does the administration’s plan yesterday tell us about the future prospects of Medicaid and health care for the poor in NC?  Here’s my take:

1. Surrender:  The Governor completely surrendered by backing down from his former big plans to sell off substantial parts of the Medicaid program to private, out-of-state insurance companies.  The proposal yesterday to use “Accountable Care Organizations” or ACOs is simply, at its core, a new way to pay existing or new networks of doctors, hospitals and other health care providers.  Paying health providers as a group for each illness a patient gets rather than piecemeal for every test and procedure is supposed to get providers focused on quality and efficiency, especially when payments go up if patients are healthier. ACOs represent gradual evolution in health care and not “major reform.”

2.  Missing the boat on Medicaid expansion: The Governor also made it clear that he has no intention of solving the coverage gap for the 500,000 poor North Carolina citizens who would be eligible for Medicaid coverage if he led the charge to expand Medicaid using the billions of dollars in federal money available to our state. Conservative governors and legislators around the country – whether in New Hampshire or Utah – are coming up with innovative solutions to cover their citizens with all the new federal money available.  By leaving an expansion proposal out of his plans to change Medicaid, our Governor is renouncing any claim to national moderate leadership on this issue, leaving billions of federal tax dollars collected from North Carolinians to go to states that do expand and hurting hundreds of thousands of his own constituents.

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The state’s health agency revealed its proposal yesterday of how to it wants to overhaul the state’s Medicaid system, giving a broad outline that appeased doctor and hospital groups and backed away from earlier promises of a privatized system.

In a meeting held Wednesday for a Medicaid reform advisory group, N.C. Health and Human Services Secretary Aldona Wos and her staff said they would, with the legislature’s blessing, move to a  model using Accountable Care Organizations (which can be groups of medical practices or hospital systems) to manage Medicaid patients physical health needs.

DHHS Sec. Aldona Wos

DHHS Sec. Aldona Wos

“What we are presenting today is a realistic and achievable plan that puts patients first, helps create a sustainable Medicaid program, and builds on what we have in North Carolina,” Wos said, in a press release about Wednesday’s meeting. “This proposal represents a fundamental improvement in how the state delivers Medicaid.”

Wos will present the plan March 17 to lawmakers, any changes will also need federal approval.

(Scroll down or click here to read the two-page handout on the proposal.)

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Medicaid gap2In case you missed it yesterday, the Wall Street Journal featured a powerful article on the terrible toll that is resulting from the failure of 25 states (including North Carolina) to expand Medicaid under the Affordable Care Act. The article – “Millions trapped in health-law coverage gap” tells the story of low-income workers like Ernest Maiden of Birmingham, Alabama who make too much to qualify for their own state’s Scrooge-like Medicaid programs, but not enough to qualify for federal subsidies under the ACA. (There are as many as 500,000 Ernest Maiden’s in North Carolina):

“Ernest Maiden was dumbfounded to learn that he falls through the cracks of the health-care law because in a typical week he earns about $200 from the Happiness and Hair Beauty and Barber Salon.

Like millions of other Americans caught in a mismatch of state and federal rules, the 57-year-old hair stylist doesn’t make enough money to qualify for federal subsidies to buy health insurance. If he earned another $1,300 a year, the government would pay the full cost. Instead, coverage would cost about what he earns.

‘It’s a Catch-22,’ said Mr. Maiden, an uninsured diabetic. Read More