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A new report from Cone Health Foundation and Kate B. Reynolds Charitable Trust finds that North Carolina lost out on billions of dollars and thousands of jobs by refusing to close the Medicaid coverage gap in 2014 and 2015. If the state acts in 2016, however, we can recoup some lost ground by covering 500,000 more people. Such a move would create 43,000 new jobs by 2020 and reap $1 billion in tax revenue for the state and counties. Closing the coverage gap would save the state budget more than $300 million by 2020.

As followers of this blog know the state had a chance, starting in 2014, to expand Medicaid eligibility to all individuals and families earning less than 138 percent of the federal poverty level. More than half the states have now opted into this deal and they are attracting a huge return on investment. This new report is the first of its kind in the nation that takes a detailed look at every county in the state and uses a nationally respected model to estimate the impact of Medicaid expansion on tax revenue, job creation, business activity, and coverage.

The results are startling. In Robeson County expanding Medicaid would generate more than 700 jobs. In Moore County it would create nearly 500 jobs. In Nash County it would create more than 300 jobs. This is the equivalent of a fleet of new large employers locating in dozens of communities across the state. The increased economic activity will produce more county tax revenue at a time when many local governments are sputtering by on fumes. For Wake County, Medicaid expansion would net more than $25 million in tax revenue. It would earn Guilford County more than $11 million.

New data confirms in finer detail what we have always known, expanding Medicaid eligibility is a no-brainer. Thankfully, Gov. McCrory seems to be moving to the right (or should I say correct) side of this issue. Now that the federal government is allowing governors and legislators the flexibility to design state-specific expansions Wyoming, Indiana, Utah, and Tennessee — hardly redoubts of liberalism — are starting to embrace expansion. We should follow suit.

This is a rich report that deserves a close reading. You can find some reporting on it here, here, here, and here.

 

 

Commentary
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As we report below the US Supreme Court has decided to hear another legal challenge to the Affordable Care Act.

You can read the details of the lawsuit in our earlier post, but some context is important. This new fight focuses on subsidies extended to individuals and families earning less than 400 percent of the federal poverty level who purchase private insurance. For these families subsidies are available to make insurance plans more affordable. In North Carolina about 91 percent of people purchasing Affordable Care Act plans received subsidies. Of those, the average cost of insurance is $81 per month.

News coverage of the Supreme Court’s move, coming just before open enrollment is set to start, is sure to cause confusion. In the short term it is critical to remember that the subsidies are still in place and everyone should proceed to shop for insurance without worrying about the political winds.

In the long term it is difficult to know what this case will mean for the law. The challenge is absurd, but that doesn’t give us any hint at how the Supreme Court Justices will vote. Read More

Commentary
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Funeral

Photo: NC NAACP

As the North Carolina NAACP holds a “Denial of Medicaid Funeral Procession” today, it’s worth considering some of the facts and data surrounding the impact of North Carolina’s ongoing refusal to expand Medicaid under the Affordable Care Act:

The North Carolina Institute of Medicine’s 2009 Access to Care study begins with this statement: “The lack of health insurance coverage is the foremost barrier to accessing health care services.”

In the report’s introduction it continues:

In a statewide survey of adults, nearly half of the uninsured in North Carolina reported forgoing necessary care due to cost, compared to 10% of individuals with insurance coverage. Lack of coverage also adversely affects health as the uninsured are less likely to get preventive screenings or ongoing care for chronic conditions. Consequently, the uninsured have a greater likelihood than people with coverage of being diagnosed with severe health conditions (such as late stage cancer), being hospitalized for preventable health problems, or dying prematurely. In fact, adults who lack insurance coverage are 25% more likely to die prematurely than adults with insurance coverage.

A Families USA report in 2010 estimated that before the Affordable Care Act passed nearly 1,000 North Carolinians died each year between 2005 and 2010 due to lack of health insurance.

What has changed is that the states now have an unprecedented tool for saving lives. North Carolina now has the opportunity to extend health insurance coverage to nearly all low-income adults, the majority of whom are working. The federal government will finance nearly the entire cost of this coverage expansion. Not expanding coverage is not only morally misguided but it is also fiscally irresponsible. Read More

Commentary
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In an opinion piece published this morning by the News and Observer, Hendersonville high school English teacher Chris Gilbert acknowledges the recent pay raise bestowed upon teachers by state lawmakers (significant for some and minuscule for others), but says he believes it is not demonstrative of politicians’ renewed commitment to public education.

Now, certain politicians can claim [the teacher pay raise of 2014] represents a renewed commitment to public education, and they secretly hope the pay increase will distract us from recent events that challenge this false narrative and reveal their true intentions.

We, however, have not forgotten the recent past.

We remember the recent plan to “reward” the top 25 percent of a district’s educators with small raises in exchange for relinquishing due process rights.

We remember that North Carolina’s teachers were recently among the lowest paid in the country.

We remember the passing of a state budget that led various districts to cut teacher assistants.

We remember a damaging bill passed last year that eliminated class size caps in early grades.

We remember the reduction of textbook funding from over $111 million in 2009 to $23.3 million in 2014.

We remember the implementation of the unconstitutional voucher program that siphons funds from public education to private schools.

We remember changes to the tax structure that have decreased revenue and threatened sustainable funding for teacher pay, our education system and other essential services.

This list could certainly continue, but the point should be clear: Recent state history reveals serious intent, and multiple attempts, to dismantle public education in order to justify privatization and create profit opportunities in the public sector.
News
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An investigation by the Wisconsin State Journal has found that Wisconsin’s taxpayers have lost $139 million dollars over the past ten years to private schools that have received funds from the state’s voucher program but were ultimately excluded from participating, thanks to their failure to meet standards relating to finances, accreditation, student safety and auditing.

From the State Journal:

More than two-thirds of the 50 schools terminated from the state’s voucher system since 2004 — all in Milwaukee — had stayed open for five years or less, according to the data provided by the state Department of Public Instruction.

Northside High School, for example, received $1.7 million in state vouchers for low-income students attending the private school before being terminated from the program in its first year in 2006 for failing to provide an adequate curriculum.

Recouping money sent to shuttered schools isn’t a feasible option, since the money is gone, Bender and Olsen said. [Bender is president of School Choice Wisconsin and Olsen (R-Ripon) is the Senate Education Committee Chairman]

Unlike North Carolina’s school voucher program, which is currently in the infancy stage and may or may not survive a court battle in which it has already been declared unconstitutional by a Superior Court judge, Wisconsin’s voucher program has a (relatively) robust set of accountability standards.

To participate in Wisconsin’s school voucher program, schools must do the following, according to the State Journal:

Currently, schools wishing to participate in the program must meet requirements for the training of their staff, obtain academic accreditation, present a complete budget and submit information to DPI about their governing body or policies and contract with a third-party service to handle payroll taxes.

Private schools participating in North Carolina’s voucher program are not required to do any of the things that Wisconsin schools must demonstrate.

Instead,the North Carolina’s private schools are free to hire untrained people to teach, are not required to be accredited or meet any curricular requirements and do not have to share details of their budget or governing body with the state or public. Among the very few requirements they must meet include administering a standardized test annually, complying with health and safety standards and conducting a criminal background check for only the head of the school.

While the courts decide if our state’s voucher program should survive, North Carolina has already disbursed more than a million dollars in taxpayer-funded vouchers to private schools across the state — including $90,300 to Greensboro Islamic Academy, which an N.C. Policy Watch report found to be experiencing significant financial troubles just last year.

Read the full story on Wisconsin’s voucher program here.

 

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