Commentary, News

Wake Forest researchers: NC should close the Medicaid gap now

Medicaid expansionStill more experts have weighed in in favor of following the lead of dozens of other states and expanding Medicaid in North Carolina. A new report by a pair of Wake Forest University professors of health law says that North Carolina leaders are making a mistake by refusing to act. Click here to read “Medicaid Expansion Costs in North Carolina: A Frank Discussion.”

Here’s the conclusion:

“There is no denying that Medicaid expansion in North Carolina will have some costs. And, for those who distrust the federal government with a fiery passion, there may be nothing that can convince them to consider this major expansion of federal support. However, a more dispassionate examination of the issues greatly reduces well-founded concerns over expansion costs to the state.

Several expert studies have calculated what actual expansion costs would be, and what portion of those costs the state would actually bear. Expansion funding, like an iceberg, has both a visible tip, and a much larger hidden part below the surface. The tip of expansion costs, which are several billion dollars a year, is the 10 percent that the state would have to pay. The federal government pays the rest. That much larger, 90%-hidden part of the iceberg represents not a cost to the state, but instead money coming into the state.

This new federal funding melts throughout the state’s economy. The increased federal funds would create new well-paying jobs and boost economic activities that increase tax revenue without increasing tax rates. Expansion would also create savings for the state by reducing what it has to spend both on existing Medicaid recipients, and on other non-Medicaid programs like mental and substance abuse treatments and medical care for inmates. And, federal funds reduce what state and local governments currently pay for free care that now goes to low- income people who lack insurance. All told, these economic benefits and savings to state and local governments will approximately equal the extra costs to the state of expansion.

That math works as long as the federal government does not reduce what it will pay for North Carolina residents on Medicaid. Although the ACA has survived every one of the legal and political challenges it has faced, there is no guarantee that federal support will continue forever. However, it would be both illogical and extremely difficult for the federal government to back out of its deal with the states now. Even if some risk remains, states are not defenseless; they can take several steps to protect themselves, in the form of triggers, sunsets, or waivers.

The question, then, for the people and the leaders of North Carolina, is whether a small cost and a small risk are prices worth paying to provide insurance coverage to several hundred thousand people who cannot afford coverage on their own, even though the majority of them are working.”

News

Once again Affordable Care Act is back before the U.S. Supreme Court

Health careThe U.S. Supreme Court has agreed for a fourth time to wade through an Obamacare dispute, this time in several consolidated cases involving the contraceptive mandate.

This from the Associated Press:

The newest “Obamacare” case involves objections by faith-based hospitals, colleges and charities to the process the administration devised to spare them from paying for contraceptives for women covered under their health plans, and yet ensure that those women can obtain birth control at no extra cost.

The groups complain that they remain complicit in making available the contraceptives in violation of their religious beliefs.

Seven out of eight federal appeals courts have agreed with the administration that requiring the faith-based groups to make their objection known and identify their insurer or insurance administrator does not violate a federal religious freedom law.

Argument in the cases is expected in March 2016.

Commentary

Voters in battleground states say the ACA is here to stay

The following is a press release from our friends at ActionNC about powerful polling that shows most voters in battleground states want to move on from the obsession with repealing health reform to a mature discussion of how to improve the law. After more than five years the Affordable Care Act is getting some age on it, and we have learned important lessons from implementation. But we can’t make the law better if lawmakers don’t first accept that it’s a law that is here to stay. As usual, the public has to lead our leaders.

FOR IMMEDIATE RELEASE

October 7, 2015

Contact: Kevin Rogers, 919.862.4009

kevin@actionnc.org

Survey Shows that Voters Believe “ACA is Here to Stay”
Elected Officials Need to Improve Law; Not Repeal It

(Raleigh, NC) — A new survey shows that the majority of likely voters in five key battleground states – Florida, Nevada, Ohio, Pennsylvania and Virginia – believe the Affordable Care Act is here to stay (64%) and that Congress should work to improve the law (71%).

The survey, which was released by Community Catalyst and Service Employees International Union (SEIU), found that likely voters prefer a candidate who will work to improve the law over one who would repeal it (55% vs. 40%). Most agreed elected officials should “stop wasting time” trying to repeal the law (58%) and instead focus on a variety of improvements to lower the cost of care.

“These research findings confirm what we continue to hear over and over across North Carolina. People are frustrated with repeated efforts to repeal the ACA. It’s time to recognize that the law is here to stay.” said Kevin Rogers, Policy Director for Action NC. “We need to move forward to find ways to continue to lower health care costs for people and address issues such as high copayments and escalating drug prices.”

“Voters understand that the law has led to some important outcomes such as guaranteeing coverage for people with pre-existing health conditions. This research shows that they now want their elected officials to work together to make improvements that favor patients over insurance companies and pharmaceutical companies,” said Rogers.

The survey showed strong support across party lines for improvements that are being considered to lower health care costs, including:

  • Require hospitals and other health care providers to be transparent about their prices so people understand what the cost of services will be before they use them (75% strongly support)
  • Change the way insurance companies pay doctors and hospitals to create incentives to keep people healthy rather than paying providers based on the number of tests and procedures they give (64% strongly support)
  • Give Medicare the power to negotiate drug prices (63% strongly support)
  • Expand tax credits to small businesses to help the afford employee health insurance (61% strongly support)
  • Give state insurance commissioners more authority to push back on insurance companies that want to hike up insurance premiums (57% strongly support)

The survey was conducted by PerryUndem Research/Communication September 15-19, 2015; 1,005 adults who said they were likely to vote in the 2016 elections and have a history of voting in the 2012 or 2008 elections responded. The margin of error is +/- 3.1 percentage points.

You can read more about the poll results here.

Commentary

New NC Medicaid surplus more than enough to pay state costs of expansion through 2020

Medicaid expansionFor years now, poor and working North Carolinians who would benefit greatly from Medicaid expansion under the Affordable Care Act have been held hostage as Governor McCrory procrastinated and offered excuses. First, the Guv claimed that the Medicaid system itself was “broken” and in need of repair before it could be expanded. Then, he claimed that it would be inappropriate to act until the U.S. Supreme Court ruled on the constitutionality of the ACA itself.

Today, McCrory is running out of excuses. The Supreme Court took care of the constitutionality question a few weeks ago and yesterday, McCrory himself laid Excuse #1 to rest.

According to a statement from the Governor’s office, Medicaid is now in the black:

“The Department of Health and Human Services reported today that the North Carolina Medicaid program ended the 2014-15 state fiscal year with $130.7 million cash on hand. This is the second consecutive year the Medicaid program has finished with cash on hand.”

What’s more, that surplus is more than enough to cover state costs of implementing expansion. As a December 2014 study from health policy wonks at the Milken Institute School of Public Health at George Washington University reported (see page 15), expansion will actually save the state more than $300 million over the next five years. In 2020, however, there will be a modest net cost to the state of $91.7 million.

The obvious takeaway? Even if the state flushed away the savings that expansion will bring between now and 2020, it can easily cover the modest bump in costs in 2020 merely by socking away the current surplus.

Not surprisingly, however, the Guv is already moving the goalposts. Read more

Commentary

Editorials: No more excuses for McCrory in wake of Obamacare decision

As Adam Linker noted yesterday in the post below, there are no more excuses now for Gov. McCrory:

“Now that the Supreme Court has ruled — again — that the structure of the Affordable Care Act is constitutional, it is time to move forward with making the law work better in our state.

The first, and most important, step is accepting federal funds to extend the benefits of affordable health insurance coverage to 500,000 more people in our state. Gov. McCrory said last year that his staff was assembling options to expand coverage and that he would make an announcement about his recommendation after the Supreme Court ruled in King v. Burwell. The ruling has arrived.”

This morning, major newspapers around the state are echoing this sentiment.

From the Durham Herald-Sun:

“With the question of the act’s validity answered by the court, it’s time for North Carolina
to reverse its unfortunate decision to not extend Medicaid coverage to an estimated
500,000 individuals and families too poor to qualify for the ACA subsidies.”

From the Greensboro News & Record:

“This was an enormous victory for President Obama. Most importantly, it avoids the human toll that would have resulted from an adverse ruling.

Next, North Carolina should expand Medicaid coverage for thousands of residents who still fall between the coverage cracks. State leaders should have expanded Medicaid in the first place, but seemed more intent on thumbing their noses at the president than doing what’s right. Not only is most of its cost paid for by the federal government, but also it would create as many as many as 43,000 jobs. Gov. Pat McCrory had said he wanted to wait for the Affordable Care decision first before considering that step. Now that the high court has ruled, it’s time for him to act.”

From Raleigh’s News & Observer:

“Meanwhile, Gov. Pat McCrory has shown a lack of political courage in declining to support an expansion of Medicaid, the state and federal insurance program for the poor and disabled. The federal government, under the Affordable Care Act, would pay 100 percent of the expense in the first three years and at least 90 percent thereafter. McCrory said he was awaiting the high court decision to make his own decision about pushing for Medicaid expansion. But he wasn’t. Once again, the 500,000 North Carolinians who could be helped are left to hope that a move to expand Medicaid comes before an illness or an accident does.”

In other words, come on Governor, get off your keister do the right thing!