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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.

 

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This morning consumer advocacy group Families USA released a report along with the NC Community Health Center Association and the NC Justice Center showing that most people who stand to benefit from closing our state’s health insurance gap are working. Many of these folks are in low-wage service jobs. The report also examines the top occupations in North Carolina where employees would benefit from Medicaid expansion.

There are 59,000 construction workers who would benefit from Medicaid expansion and 56,000 food service workers. When these employees are in good health we are all better off. Construction workers at home with a serious illness and food preparers with untreated diseases decrease productivity and threaten public health.

Chid care workers and home health aides are also disproportionately impacted by our state’s stance on Medicaid expansion, which means that the people who help nurture our children and tend to the elderly can’t take care of their own health needs.

It is a positive sign that Gov. McCrory says that he is keeping the door open to Medicaid expansion in the state. Still, this passive stance will not move us anywhere. If we are going to prevent unnecessary deaths, extend needed preventive care, and help the people who make our food and care for our kids then we need the Governor to lead.

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Here are two morning editorials that ought to be a “must reads” for North Carolina’s conservative political leaders:

The first comes from the Fayetteville Observer and it’s entitled “Yes, Republicans can expand Medicaid too.” As it notes:

Last month, hundreds of representatives from North Carolina hospitals and other health-care institutions brought a united message to Raleigh: Cuts in the Medicaid program are causing them serious economic harm. Further cuts could be disastrous.

That doesn’t begin to consider the financial drain that comes from treating the thousands of North Carolinians who have no health insurance at all – those who are ineligible for Medicaid but too poor to afford conventional health insurance. By law, hospitals must treat them if they show up in the emergency room, even though there is no chance that they can pay their bill….

That’s one reason why officials in Republican-led Indiana changed their minds about Medicaid participation in May, developing a hybrid state-federal system that will bring coverage to more low-income residents there.

Indiana Gov. Mike Pence, a Republican, is using the supplementary Medicaid money to fund a state health-insurance plan for low-income residents. But it will have the same net effect in bringing coverage to those who don’t have it.

That’s a lesson in that for our GOP leaders, who have resisted participation in Obamacare. Don’t resist. Take the money and build a program that works.

The second comes from the Wilmington Star News. It’s entitled: “Instead of bullying children fleeing violence, put blame where it belongs.”

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MedicaidAs Governor McCrory and his HHS Secretary Aldona Wos convene a rather strange closed door “listening  session” on Medicaid in Greensboro today (it’s scheduled to last all of 45 minutes), let’s hope they both took the time over the weekend to read an excellent, “from-the-trenches” essay by Goldsboro physician Dr. David Tayloe in Raleigh’s News & ObserverIn it, Tayloe explains the importance of preserving and improving North Carolina’s homegrown “medical home” model for delivering Medicaid services (Community Care of North Carolina) rather than falling for the false promises of out-of-state HMO companies that have been trying to muscle their way into the state.

CCNC is rooted in care coordinated by providers, not insurance corporations. By keeping care decisions in the hands of those most qualified to make them, medical home models improve health outcomes for North Carolina’s Medicaid population. Doctors, care managers and pharmacists across provider-led networks share data and best practices to provide efficient and high-quality care to patients, decreasing emergency room visits and reducing wasteful spending.

The CCNC model is the result of decades of work that has consistently generated positive results in North Carolina. An HMO takeover of this system would mean higher administrative costs to the state and billions of taxpayer dollars leaving the state to pay corporate shareholders. Under federal Medicaid rules, the additional money required to pay HMOs can come from only one place – sharp cuts to provider payments. When physicians choose not to participate in Medicaid, patients neglect preventive care and head to the emergency room in crisis, raising state costs while producing less positive health outcomes. Read More