Archives

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.

 

 

This morning’s Greensboro News & Record gets it just about right with an editorial entitled “Just the essentials.”

“The legislature’s ‘short’ session convenes today with one essential purpose: to make adjustments to the second year of the biennial state budget.

There’s other work that needs to be done, and some things that should not be done.

In the first category:

* Pay raises for teachers.

Gov. Pat McCrory outlined his proposal last week. It includes substantial raises in starting salaries and for teachers in the first few years of their careers. More experienced teachers also would see increases. The legislature should flesh out and approve a plan to improve teacher compensation and simultaneously revoke its ill-conceived directive for school systems to designate one-fourth of eligible teachers to receive bonuses if they surrender their tenure rights.

* Stricter coal ash regulation.

The massive spill of coal ash into the Dan River near Eden in February alarmed politicians of both parties who had ignored the issue of safe storage for years. Now is the time to set Duke Energy on a course of corrective action and put in place new regulations to protect water.

* Medicaid expansion.

Last year’s decision to reject federal funding to broaden eligibility left an estimated 300,000 or more residents without health care coverage. The legislature should correct this mistake.

* Preschool enrollment.

The legislature last year directed stronger efforts for schools to make sure children can read by the end of third grade but didn’t grant additional resources to get the job done. One way is to pay for more at-risk 4-year-olds to attend prekindergarten programs.

Now, what the legislature should not do…

Click here to read the rest of the editorial.

Health-Reform-SBHere’s this morning’s most important and thus far under-reported news story in North Carolina: the huge spike in enrollment numbers in health insurance as the result of the Affordable Care Act.

This is from a story (buried on the business page, for some reason) in Raleigh’s News & Observer:

“North Carolina enrollments for health insurance surged to 357,000 as tens of thousands of residents signed up for subsidized coverage in the final weeks of eligibility, the U.S. Department of Health and Human Services said Thursday.

The late rush of insurance enrollments under the Affordable Care Act elevates North Carolina to the fifth-highest slot in the nation, surpassing most expectations for the law’s first year of enrollment, particularly in a Republican-controlled state that did not run its own insurance exchange.

Enrollments here represent a third of the state population eligible for health insurance, and are expected to take a significant chunk out of North Carolina’s uninsured population, which was 17 percent in 2012. Almost all of North Carolina’s enrollments came with federal subsidies for the applicants, suggesting that many of those signing up had been unable to afford coverage in the past.”

Moreover, another 74,000 have been obtained coverage under Medicaid. As Chris Fitzsimon notes this morning in Friday Follies, despite all of the imperfections and all of the relentless opposition and innumerable obstructions thrown at the ACA by the ideologues on the right, President Obama and the other architects of health care reform have fashioned a remarkable achievement — they have dramatically improved the lives of millions of Americans (including more than 430,000 North Carolinians) in a profound and irreversible way.

No wonder conservative politicians are getting more and more concerned about the political implications of their ongoing and increasingly futile efforts to oppose and repeal the ACA.

Read more here: http://www.newsobserver.com/2014/05/01/3825943/nc-enrollments-for-subsidized.html?sp=/99/104/#storylink=cpy