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A new report from the Robert Wood Johnson Foundation and Urban Institute shows the financial folly of rejecting Medicaid expansion. Currently 24 states are refusing federal funds to cover more of the uninsured, although that number is quickly dwindling as more governors and legislators get approval to implement state-specific expansion plans. If North Carolina does not act soon we will find ourselves in lonely company.

Here are the numbers. On average, the Urban Institute finds that every $1 invested in Medicaid expansion will bring $13.41 in federal funds to the state. In North Carolina the 10-year cost to expand Medicaid is $3 billion, although the savings and cost offsets mean that the state would actually save money in the budget over that timespan. At the same time our state is losing nearly $40 billion over 10 years by not expanding Medicaid. Hospitals in our state stand to lose $11.3 billion over 10 years, which is why we are seeing layoffs and closures at hospitals across North Carolina.

This financial picture has convinced even rock-ribbed Republican governors across the country to champion expanding coverage in their states. Many of these political leaders from Arkansas to Iowa, Indiana to Utah, are proposing to increase coverage by applying for a Medicaid waiver that allows these states to use federal funding to craft creative alternatives to traditional Medicaid expansion.

Arkansas led the charge on this front by using expansion funds to buy private insurance coverage for low-income individuals and families in that state. And we see that Gov. Mike Beebe certainly hasn’t suffered by doing the right thing. He currently enjoys a 60 percent approval rating compared to 23 percent who disapprove of his policies. Despite being a Democrat his ratings are even above water with Republican voters. Compare this with Gov. McCrory who is having trouble cracking 40 percent in his approval ratings.

Gov. McCrory could add some polish to his image by expanding health coverage to 500,000 more people, bringing $40 billion in federal funds to the state, and boosting hospital bottom lines by $11 billion. Who knows, it may even help the legislature pick its approval ratings up off the floor.

 

NC Budget and Tax Center

Budget writers announced over the weekend that the Senate and House leadership agreed to a basic framework for a final budget deal. That framework includes a pay raise for teachers averaging roughly 7 percent and further cuts to the Medicaid program that provides health insurance and long-term care to children and adults who are poor, disabled, and elderly. There is no question that other vital programs and services will be cut due to a lack of adequate funding, resulting from lawmakers’ choice to make room for unaffordable tax cuts for the wealthy and profitable businesses in 2013.

While the full details of the final budget deal will not be released until this afternoon at 1:30pm, below are five things we expect to be true in the final budget deal: Read More

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Veteran Washington Post columnist Dana Millbank gets things just about right in this new essay about the stubborn refusal of the state’s conservative political leaders to expand Medicaid under the Affordable Care Act. Millbank’s column was inspired by Belhaven mayor Adam O’Neal’s march to Washington that was designed to highlight the plight of his small town that lost its hospital thanks the state’s Medicaid decision:

O’Neal arrived on Capitol Hill carrying his hiking pole and wearing trail shoes, shorts and a “Save our Hospital” T-shirt. He was accompanied by about 250 supporters, most affiliated with labor unions, and by civil rights leaders. The hospital closure disproportionately affects African Americans. But Gibbs is white, and so is Crystal Price, who, with her young son, joined the mayor on the stage.

Price, 27 and an employee at Wendy’s, has no health coverage and spoke tearfully about her cervical cancer. “They don’t want to expand Medicaid, so families like mine .?.?. have to decide if we’re going to pay for our children’s health care or our own,” she said. “How many have to bury their loved ones, and how many children like my own will have to grow up without a parent because you want more money in your pockets?”

For O’Neal, any ideological doubts about Obamacare are dwarfed by the disgrace of a young working mother unable to get cancer treatment.

“I mean, that’s wrong,” he said. “Conservatives — everybody — should think that’s wrong.”

Read Millbank’s entire column by clicking here.

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This morning’s Greensboro News & Record makes some sound points in assessing the split in the federal courts over the Affordable Care Act and the availability of subsidies in states without state-based exchanges.

While the editorial (which is entitled “Save the subsidies”) acknowledges the ambiguity of some of the language in the statute, it also rightfully calls for judges and lawmakers to apply common sense in interpreting and applying it.

As it notes:

“Yet, it [the inartfully crafted statute] could be fixed easily. Congress could pass a technical correction, making plain its original intent that subsidies should be made available across the country. Republicans won’t agree to that, preferring to see the program collapse.

North Carolina could provide a remedy for its residents, creating a state exchange and allowing them to sign up again for coverage. Our state’s Republicans won’t do that, for the same reason. They would rather stick to their opposition, even if more than 300,000 residents lose their medical coverage. It’s all about politics.

For now, after Tuesday’s contradictory rulings, the legal question is still open. Politics seems to influence the courts as well. The three judges on the Richmond panel were appointed by Democratic presidents. The two who produced the majority opinion in Washington were nominated by Republican presidents. If the full D.C. court hears the case on appeal, a reversal is expected because most of the court’s judges are Democratic appointees.

It would be refreshing to see a ruling made on the legal merits of a case, rather than politics.

Also helpful would be consideration for what’s really best for the public. The ACA intends to improve access to medical care. Whether the enrollment mechanism is a federal or state exchange shouldn’t matter, and judges should apply common sense to their final decision.

Read the entire editorial by clicking here.

 

 

 

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MedicaidNorth Carolina doctors pulled no punches in their review of the Medicaid “reform” (i.e. privatization) plan adopted by the state Senate today. This is the official statement from the NC Medical Society:

“Today the Senate had a clear choice between the health of our state’s most vulnerable citizens and the health of Wall Street corporations, and they chose the corporations. Despite strong alternative proposals from the North Carolina House, Governor McCrory and the health care community on the best way to improve patient care and quality and provide budget predictability, Senators voted against this consensus. These outside managed care companies have a dismal history of success (see the examples below). The Medical Society would like to recognize and appreciates the bipartisan support for the consensus plan of the health care community, the House and the Governor today on the Senate floor. It appears that the 28 senators who voted for managed care are not aware or don’t care about the negative history of managed care and are welcoming them to North Carolina.”

For instance,

• Kentucky moved 550,000 of its Medicaid patients to three national managed care corporations in 2011. Since then, a 2012 evaluation by the Urban Institute found that patients faced delays in getting care, and there was an adversarial relationship between the managed care plans and the medical community. State legislators continue to be flooded with complaints and passed a bill to set up an appeals process at the Department of Insurance to mediate disputes between the medical community and the plans. One of the managed care plans pulled out of the state last year, suing the state saying it lost money and forcing 125,000 patients into the other two plans.
• In Illinois, a federal judge awarded over $334 million in a fraud lawsuit against the Medicaid HMO Amerigroup Illinois and its parent company, Amerigroup Corporation, for systematic and extensive fraud for discriminating against pregnant women and those with expensive medical conditions.
• In Georgia, their Medicaid program was fined $3.7 million for consistently refusing to pay for authorized care.