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Leslie Boyd

Yesterday at the Moral Monday rally on Halifax Mall behind the state Legislative Building, one speaker did an especially good job of pointing out the double standard of many “pro-life” politicians. Leslie Boyd, a person familiar to NC Policy Watch readers, explained that when she was advised to have an abortion because her unborn son had a virus, she “chose life” by opting to carry the pregnancy to term. However, when he later acquired an illness that would prove fatal without treatment, the same politicians who encouraged her to “choose life” deprived him of life by denying him the healthcare he needed. Boyd eloquently proclaimed that his blood was on their hands, and that they were, in effect, responsible for his death.

Boyd is right, of course. If politicians are going to demand that women “choose life” before a child is born, the least they can do is assure that after a child is born, s/he receives the necessary healthcare everyone deserves. Otherwise they are advocating a double standard, and at that a very strange one: the unborn life is treated as more worthy of protection than those who are already living in this world. As long as North Carolina politicians seek to prevent the implementation of the Affordable Care Act and to block Medicaid expansion while also shrinking Medicaid, those of insufficient income for necessary health expenses – as many as 2,800 per year according to some estimates – will suffer the loss of life, whether their own or the lives of loved ones.

Michael Dise is currently a seminary student at Wake Forest Divinity and a summer intern for the NC Justice Center. 

Medicaid expansionMedicaid — the absurd failure to expand it at federal expense for a half-million low-income North Carolinians and the state Senate’s latest remarkable proposal to slash the program still further– remains front and center in the state policy debate these days. Moral Monday protesters highlighted the issue last night and the real life stories of average working people whose lives are darker and shorter because of legislative leaders’ Scrooge-like behavior continue to pour in. Tomorrow, activists from an array groups will gather at the General Assembly to lift up this most obvious of issues once again.  Here’s yet another story that makes the case from the good folks over at Women AdvaNCe and Planned Parenthood:

Stuck in the Medicaid gap
By Emily Callen

A few weeks ago, while talking to people about Medicaid expansion at a festival in downtown Raleigh, I met Linda. Though she seemed tired after a day at work and was probably eager to change out of her Bojangles uniform, Linda took the time to talk to me. “I really need this,” she said, filling out a postcard urging legislators to take action. “I tried to sign up for Obamacare but it was just too expensive.”

I learned later that Linda, who considers herself generally healthy, had been in a car crash last December. Broken bones kept her out of work for a few weeks, and she still sees an orthopedist because her collarbone hasn’t healed yet. Since Linda doesn’t have insurance, she’s worked out a deal to pay her doctor a little bit each month. It will take her a long time to pay off the bill, and in the meantime she will continue to struggle to make ends meet.

Linda’s experience is not uncommon. She is one of over 300,000 North Carolinians who fall into the Medicaid Gap; Read More

Since assuming office Gov. McCrory has throttled the theme that Medicaid is broken and must be reformed. He began by offering a radical proposal of dismantling our current system and selling it off to private insurance plans. He has since backed away from that idea and now wants a more modest expansion of what currently works in Medicaid.

The House, in a bipartisan bill filed this session, clearly agrees with the Governor’s new approach. The legislation, spearheaded by Rep. Nelson Dollar, would build Accountable Care Organizations (or ACOs)  in Medicaid. These provider led ACOs would move us toward greater integration of care and away from fee-for-service medicine. Medicare is using the ACO model as are many private insurers. In fact, Medicaid is one of the only payers in the state not moving to this method of organizing care.

In its budget, the Senate flatly rejects this approach. That chamber wants Medicaid to move to full capitation. In other words, legislators want to provide a set budget to Medicaid. The insinuation is that the Senate prefers the Governor’s original plan to pay private insurers to care (or not care, as the case may be) for our most vulnerable citizens.

The Senate also engages in some fantasy by pulling Medicaid into a freestanding department that will engage the nation’s best health care minds in this ambitious reform effort. At least that’s how Sen. Louis Pate described the proposed process. The trouble, of course, is that the nation’s best health care minds consider North Carolina’s Medicaid program to be an important model and they aren’t interested in helping to dismember it. The nation’s best health care minds also aren’t interested in coming to our state and spending time tearing apart care for low-income people as the legislature reduces services, limits eligibility, and slashes the budget. We are, in short, engaged in the opposite of innovation.

Rep. Dollar is a smart chap and likely realizes that his ACO bill isn’t going anywhere as a piece of legislation. That means he will need to stick the proposal into the House budget to give it a fighting chance. Hence, the showdown mentioned in the title of this post.

Certainly the House is moving in a better direction. But it’s a good time to reflect that Virginia is having its own budget battle over Medicaid right now. Except instead of fighting over how to fiddle with (or blow up) a program that is working, Virginia’s leaders are having a serious discussion about using federal funds to expand Medicaid coverage to 400,000 people. If that happens it means that our tax dollars will help boost Virginia’s economy, bolster its rural hospitals, and support its citizens.

That will certainly be charitable of us, but not wise.

Senate leaders are looking at major cuts to health and human services programs that serve the poor, disabled and elderly in order to pay for teacher raises and fund Medicaid to required levels.

DHHSThe North Carolina chapter of the AARP has a good rundown here on what some of the proposed cuts will do, and the group says it is “disheartened to see the Senate budget proposal doesn’t value our state’s older adults and those who are blind and disabled.”

The state’s doctors are also concerned about the cuts to Medicaid system, and how it will affect some of the most vulnerable North Carolinians.

Robert Seligson, the head of N.C. Medical Society, denounced the state Senate’s budget proposal Thursday, saying it offers “no solution to the big challenges we’re facing in Medicaid.”

“Patient care under the Senate plan will suffer, especially for the aged, blind and disabled citizens of our state, who will no longer be eligible for Medicaid if the Senate has its way,” Seligson said in a statement.

Read More

Last October Gov. McCrory caused a stir, and raised some eyebrows, when he said that the state may be forced to expand Medicaid due to a “new” regulation.

The policy to which he was referring is called presumptive eligibility. Presumptive eligibility allows states to give permission to hospitals and other providers to temporarily enroll certain people in Medicaid. North Carolina, for example, allows presumptive eligibility for pregnant women. That means if a hospital does an initial check and it looks like a pregnant woman is likely to qualify for Medicaid then the hospital can temporarily enroll her and get paid for the services it provides. Meanwhile, an application for full Medicaid can be processed without a disruption in care.

This policy is critical for ensuring that patients get care and providers get paid.

In states with efficient systems that can process Medicaid eligibility in real time, this temporary measure is not as important. In states where parents are having to ration medicine for their children due to a backlog in processing Medicaid applications, presumptive eligibility is a critical tool.

Health reform gave hospitals more latitude to presumptively enroll patients, even if the state has not granted the hospital permission to participate in the program. Other providers, notably Community Health Centers, however, are still not able to use presumptive eligibility to enroll children in Medicaid. The Community Health Centers are still limited to enrolling pregnant women.

Ultimately, the state needs to fix its computer system. In the meantime, we need to get care to children. We could start by granting Community Health Centers, and possibly other providers, the ability to temporarily enroll likely eligible kids in Medicaid while DHHS clears its application bottle neck.

And until the state expands Medicaid to all low-income people we will need every splint and bandage we can find to patch our broken system.