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nci-vol-2174-300The White House Council of Economic Advisers released a report today detailing the health and economic consequences of refusing to accept federal Medicaid money to expand insurance coverage in North Carolina.

If the state accepted federal funds we could provide insurance coverage to 377,000 more people. This influx of federal money would also create jobs and boost our economy. And reducing our uninsured rate would have salutary impacts on the lives of those able to obtain affordable health care.

For example: 27,000 women would gain access to to recommended health screenings; 90,000 people would gain access to a medical home; 50,000 more people would report that they are in good health. The individual financial impacts are no less dramatic. Closing the coverage gap here would mean 17,000 fewer families facing catastrophic medical bills and 53,600 fewer people borrowing money to finance their health needs.

Some claim that North Carolina can’t afford to extend health coverage to more people. When you look at the numbers it’s clear that we can’t afford not to expand coverage. In 2014 the state is giving up $2.7 billion in federal funds. In 2015 that increases to $3.2 billion. In 2016 it’s $3.6 billion. In 2014 we could create 8,700 jobs. In 2015 we could create 19,400 jobs. If a private company or a new military base opened in North Carolina that created 19,000 jobs, politicians would be elbowing each other to get to the ribbon cutting.

The Council of Economic Advisers calls the decision to refuse new Medicaid funds a “missed opportunity.” That’s an understatement; it’s more like a terrible shame.

 

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In case you missed it, be sure to check out today’s edition of the Fitzsimon File in which Chris explains what’s really at issue in the stalemated state budget negotiations. Most notable on the list: the remarkably regressive positions of Senate President Pro Tem Phil Berger.

“Senate President Pro Tem Phil Berger told WRAL-TV that any budget deal must not only include the Senate’s estimates of Medicaid costs but must also reduce the number of people who are covered by the program.

Berger said the Senate wanted ‘reductions in the welfare spending that is ongoing at the present time.’  Medicaid, the health care safety net for the most vulnerable people in North Carolina, is now welfare in Berger’s far-right view of the world.

The budget the Senate passed earlier this session would kick at least 5,200 aged, blind and disabled people off of Medicaid. More than 1,600 of them have Alzheimer’s or dementia and are in special care units, which to Berger must be a new fancy way of saying welfare.”

As Chris also notes, there is an easy way out of the mess: Read More

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The N.C. Department of Health and Human Services released a cheerful video this afternoon touting the supposed successes of the state’s new Medicaid billing system that delayed payments for thousands of medical providers for months over the last year.

The nearly 4-minute video produced by state employees includes interviews set to upbeat instrumental music with several providers and DHHS officials talking about how well the complicated Medicaid billing system is working one year after its bungled July 1, 2013 launch.

Much of the system is working now, and providers are getting paid faster than before, DHHS officials say in the video.

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 N.C Tracks replaced the state’s previous 25-year-old Medicaid system and came online despite warnings in a May 2013 performance audit from the state auditor’s office that DHHS hadn’t fully tested the system, left too much up to vendors’ discretion and had no way of knowing ahead of time if the system was ready.

The billing problems have left legislative fiscal research staff without firm budget numbers on the $13 billion program, a major point of contention in the current budget negotiations for Republican state Senate leaders.

Missing from DHHS’ birthday video were some of the choicer statements doctors, lawmakers and others have had about new system and its rollout last year under N.C. DHHS Secretary Aldona Wos.

Here’s a few of the less-than-glowing comments:

  • “NCTracks has made billing go from complex to borderline impossible,” said Sandra Williams, chief financial officer of Cape Fear Valley Health System, at an October legislative hearing.
  • “NCTracks was a disaster, and the State was beyond the point of no return,” lawyers wrote in a lawsuit filed by medical providers in January against the state agency.
  • “We are pretty much in the dark with trying to figure out where we are in the current year,” said Susan Jacobs, a fiscal analyst for the legislature in January about getting budget data from N.C. Tracks.
  • “It’s June 19 and we still don’t have the numbers,” Sen. Tom Apodoca, a Hendersonville Republican, said in a hearing earlier this month about Medicaid budget information, according to the News & Observer. “If push comes to shove, we can always issue subpoenas.”
  • “We are having to manually key claims and do things that before would pay automatically,” Laura Williard of High Point’s Advanced Home Care told WNCN in early June. “At one point, I had 11 temps working for our company to do something that was paid automatically before.”
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…is highlighted in this fine editorial in the Charlotte Observer entitled: “Expand Medicaid – It has value in NC.” To quote:

“N.C. lawmakers don’t seem inclined to reconsider their unwise decision not to expand Medicaid. But that doesn’t mean we should stop shouting loudly why they should. A new Robert Wood Johnson Foundation report last week underscores the value for the Tar Heel state.

The report looked at the Affordable Care Act’s impact in 14 large U.S. cities. Charlotte was among the seven cities in states where lawmakers opted not to expand eligibility for Medicaid. Even so, the number of uninsured Charlotte residents is expected to drop by 36 percent, or 63,000, by 2016 because of ACA. That was the highest drop among cities with no Medicaid expansion. Among all states, North Carolina has the fifth-highest ACA federal online sign-up.

The report points out that had North Carolina expanded the state’s Medicaid program for low-income and disabled residents, the decrease in uninsured in Charlotte would be even greater – an estimated 57 percent. That would be an additional 36,000, bringing the number of Charlotte residents gaining insurance to 99,000 by 2016. Read More

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In a good conversation with Becki Gray yesterday on News 14 we discussed the different visions for Medicaid reform proposed in the respective budgets of the Governor, House, and Senate. In particular, Gray, who works for the John Locke Foundation, noted that the state has a “rich” benefits package in Medicaid because we offer many optional services, that is, services that are not required to be covered by the federal government. The Senate, she correctly pointed out, wants to whittle away these optional services.

Ending optional services in Medicaid is a popular policy among conservative think tanks in the state. Apparently the Senate is listening.

As this debate progresses it is important that we know what services we are talking about when we talk about optional services. Let’s review a few: transplants, prescription drugs, dentures, hospice, prosthetics. None of these treatments are frivolous or lavish.

And that’s the trouble with optional services. If you want to get at some of the more expensive options then you are limiting life-saving care. Former Locke Foundation analyst Joe Colletti even praised Arizona for cutting optional services like transplants in a report on Medicaid reform. But these cuts inflicted so much pain in Arizona that the state made a volte-face on its decision.

That brings us to the Senate budget. Among other things the Senate wants to end the optional Medically Needy program in Medicaid. This program allows people who have enormous medical expenses, but earn too much to qualify for Medicaid, to apply these medical bills to their income to access Medicaid. This makes sense. If, for example, you earn $30,000 per year but need expensive drugs or nursing home care then these costs will quickly eat through your monthly income. Although you may have some money your medical needs erase it all. It’s not fair to tell this person that he or she is too wealthy for Medicaid when they effectively have nothing.

But this is exactly what the Senate aims to do.

As we have said many times before, “optional” refers to a regulatory requirement and does not mean anything about the necessity or quality of specific Medicaid services. You may call it foolish for the state to cover optional services. I call it basic human decency.