Real people are in the Medicaid coverage gap

The numbers are out there. For over three years the numbers have been reported on everything from how many people with diabetes could receive the medications they need to control this chronic condition to the number of jobs that could be created in each county. The numbers even show how some of the most vulnerable like children or even those that served the United States could finally gain access to the care they need if state lawmakers expanded Medicaid.

Unfortunately, the numbers have not influenced leadership in the legislature. Since the numbers and reports did not convince state lawmakers, perhaps the faces and stories of real North Carolinians will help lawmakers understand that the Medicaid Blockade hurts real people.

One real person is Kent. He is a construction worker for a small family-owned business. In fact, reports show that approximately 59,000 North Carolinians in the coverage gap have jobs in construction. Another real person is Roosevelt. He is one of the 12,000 veterans that would benefit is leadership in the General Assembly would expand Medicaid. Both of these men make too much money to be eligible for Medicaid under North Carolina’s current stingy standards, but not enough to be able to afford to but insurance in the marketplace. Roosevelt’s situation is made even more ridiculous and outrageous by the inaccessibility of Veterans Administration healthcare services.

The bottom line: It is a shame that men and women who served the country cannot get the health care they need when they need it. The Medicaid blockade is hard to justify when it impacts up to 500,000 real people. State lawmakers need to acknowledge that real people make up the numbers. They should listen to Roosevelt and others like him when they say, “I’m a human like you. I’m a citizen like you. Please do right by the people who have helped you.”

What’s at stake as legislative leaders double down on Medicaid blockade

Last week, conservative leaders at North Carolina General Assembly launched a legal attack against Gov. Cooper’s efforts to expand Medicaid. In so doing, these lawmakers went against the desires of 72 percent of North Carolinians who want to fix the health insurance gap by expanding Medicaid. Suing both the federal and state Department of Health and Human Services to prevent expansion hurts all of North Carolina. Instead of recognizing and accepting the health, social, and economic benefits of Medicaid expansion, state lawmakers are trying to extend the life of the Medicaid Blockade.

It is difficult to understand why policymakers continue to block efforts to close the coverage gap considering that up to 500,000 people could gain health coverage. A study released in 2014 examined both the preventive outcomes of expansion and the adverse health outcomes if North Carolina did not extend coverage to adults in the coverage gap. The study reported that Medicaid expansion could help prevent approximately 1,000 deaths per year. Further, Medicaid expansion could allow for nearly 27,000 people to receive medications to manage diabetes and allow approximately 12,000 women to receive mammograms.

Considering that most state lawmakers want to promote job growth and increase business activity throughout North Carolina, it is hard to believe that they continue the Medicaid blockade despite the projected economic benefits. One report shows that up to 43,000 jobs could be created by 2020, 13,228 of which are jobs in rural counties of the state. North Carolina’s vulnerable and rural hospitals would also experience an economic boost if Medicaid is expanded. In just one year, one hospital group reported a drop of $35 million in uncompensated careArkansas and Michigan are two states that reported decreases greater than 50 percent in uncompensated care. A more recent qualitative study reported that reductions in uncompensated care and the boost to health provider budgets allows for promotes increase in ways to improve on quality of care.

North Carolina has had the opportunity to improve the health and financial standing for children and families, low-wage workers, veterans, and rural residents since 2014. Tragically, state lawmakers continue to block the positive short and long-term impacts Medicaid expansion will have on our state. At some point in the near future, it seems certain that they will regret this decision.

NC’s new governor provides a welcome and long overdue initiative to close the Medicaid coverage gap

Since 2013, North Carolina law and policymakers have failed to recognize the health, economic, and social benefits of closing the Medicaid coverage gap for residents of the Tar Heel state. Today however, in a hopeful and inspiring speech, Governor Roy Cooper explained why, in order to achieve a true Carolina Comeback, the state needs to extend Medicaid coverage to the 500,000 North Carolinians in the gap.

Gov. Cooper told business leaders that expanding Medicaid is not just about health care, but about economic growth and security for all of North Carolina. He pointed out that expansion would bring billions of dollars in investment to the state and create thousands of new jobs.

Cooper was absolutely correct, of course. As of today, North Carolina has lost out on more than $5 billion in tax dollars that could have been used to provide coverage to those in the gap. According to a joint report by Cone Health Foundation and Kate B. Reynold’s Charitable Trust, North Carolina could miss out on an additional $21 billion in federal funds between 2016 and 2020. To make matters even more absurd, North Carolinians are already paying millions in tax dollars to close the gap in other states that have embraced Medicaid expansion

Another point that Cooper might have noted had he had the time is that closing the coverage gap will help nearly 15,000 families currently experiencing immediate economic distress due to the mushrooming problem of medical debt.

In addition to taking back Tar Heel tax dollars, closing the coverage gap creates jobs. In fact, expanding Medicaid could lead to 40,000 jobs by 2020. These jobs aren’t just in the urban centers of the state, either. A huge number would be in the state’s 80 rural counties. In addition to providing coverage to over 140,000 rural residents, expansion will create 13,228 jobs in rural counties. Once jobs are created, the same report shows that there will be an increase in business activity as people will start supporting businesses throughout the state. With increased business activity, counties and the state would experience a meaningful rise in tax revenues. The above-mentioned report notes that by failing to expand Medicaid this year, North Carolina could lose $161 million in state tax revenue.

Finally, Gov. Cooper noted that there are other states with conservative leadership that have experienced the health and economic benefits of expansion. While the Vice-President-elect and outgoing Indiana Governor Mike Pence says he is hoping to dismantle the ACA, Indiana’s expansion is estimated to have provided coverage to over 350,000 people. Gov. John Kasich in Ohio also supported closing the coverage gap and his commendable efforts have resulted in the enrollment of more than 400,000 Ohioans. What’s more, costs in that state have actually come in 28.7 percent below the projected budget.

Expansion states have not only experienced greater drops in state uninsured rates, but have been able to report increased access and utilization of preventive care, as well as real benefits to their economies as well.

The bottom line: Governor Cooper deserves great praise for his visionary and courageous act. While it’s clear that his plan will face tough sledding in the days ahead, it’s tremendously encouraging that he has shown himself willing to fight for this critically important cause. Let’s join our new Governor in supporting Medicaid expansion — a plan that would help all 100 counties experience health and economic benefits and do more than any other single available policy option to help spur a genuine Carolina Comeback.

Reidsville physician, scholarly reports, TV news segments show us again why NC policymakers need to close the coverage gap

Dr. Stephen Luking -- image: Cone Health Medial Group

Dr. Stephen Luking — Image: Cone Health Medical Group

Today is the first day of open enrollment for the Affordable Care Act Marketplace. And while North Carolinians have reason to celebrate the increase in coverage for many adults and families, there are still as many as 500,000 Tar Heels who would gain coverage if state lawmakers decided to fully implement the ACA and close the coverage gap.

Several recent reports — both scholarly and in the commercial news media — have brought home this point in powerful fashion.

One of the most compelling is a new video report by VICE News. The report features Reidsville family practice physician, Dr. Stephen Luking and provides powerful evidence of how the coverage gap impacts so many individuals and families throughout North Carolina. In addition to Dr. Luking, you can see the heartrending story of Angela and Roger Smith, who are forgoing their own health care to care for their son even though he has Medicaid.

The VICE News report comes on the heels of a recent report by the N.C. Poverty Research Fund that highlights how failure to close the coverage gap not only hurts individuals lacking insurance, but impacts their families, providers, and communities. The report shows how many hard working people make sacrifices like quitting their jobs to become full-time caregivers to loved ones. Once in that role, they often lack health coverage themselves and oftentimes experience poor health and financial outcomes as a result. The report also quotes Dr. Luking on the sacrifices one of his patients makes in order to care for his mother:

“I think of the caring, middle-aged man I saw recently in my office. He once had good insurance and a full-time job at a factory but had to quit his job and come home when his mother suffered a devastating illness. Otherwise, she would have been forced into a nursing home. I had placed him on several medicines for health issues. When I asked him if he had done his blood work, he started to cry. He told me he now had no insurance. The folks at social services had told him he wasn’t earning enough to qualify for insurance subsidies [under the ACA]. He now works for minimum wage 25 hours per week and told me he has been skipping medicines in order to make ends meet.”

Yet another report — this one by the Center for Children and Families — explains that over a quarter of people in the coverage gap are parents. This includes parents like Angela and Roger and Linda Dunn (who was featured in this WCTI TV report earlier this year). Both the Smiths and Ms. Dunn (and their children) would experience significant financial and health benefits if North Carolina closes the gap.

Finally, you can click here to see maps that show just how much North Carolina and the 18 other non-expansion states are falling behind compared to expansion states.

The bottom line: Yes, the ACA has helped decrease the number of uninsured in our state, but we still desperately need full ACA implementation in order to make the law work at its full potential and improve the lives and health of hundreds of thousands of North Carolinians.

Needed: Deeds to match the Governor’s words on mental health and substance abuse

RecoveryMonthProclamationSeptember is a time in which government and nonprofit advocates hold up many health awareness issues, ranging from childhood obesity awareness to healthy aging. Recently, September was named “North Carolina National Recovery Month.” Unfortunately, this latter action appears to be mostly symbolic rather than substantive.

While a signed proclamation by Gov. Pat McCrory is a nice gesture and maybe even a step in the right direction to address such a complicated health issue, it does not go anywhere near far enough. That’s because neither the Governor nor his allies in the General Assembly support the obvious policy change that would actually would do more than anything else to guarantee access to treatment for substance use disorders (SUD): Medicaid expansion.

Earlier this year, US Department of Health and Human Services released a report which found that Medicaid expansion positively impacts low-income individuals’ ability to access and utilize behavioral health, which includes SUD treatment.

In North Carolina, there are 144,000 adults that reported having mental illness or SUD that lacked health coverage who could have received necessary treatment if lawmakers had only closed the coverage gap. It is estimated that only 13 percent of adults in the coverage gap receive treatment for SUD or mental illness.

Not surprisingly, there is voluminous literature highlighting the negative social, physical, and financial outcomes when individuals with mental illness and/ or SUD cannot receive the care they need. We know that many people with SUD have co-existing physical health conditions, which may lead to a shorter life expectancy. When people cannot receive the ongoing care they need to treat SUD, it is harder for them to obtain and keep a job. Research confirms that SUD treatment helped employers save over $8,000 per worker, per year  as a result of increased work productivity and a reduction in the number of days missed from work. Compensated treatment helps reduce the economic and emotional strain on family members too.

And, of course, closing the coverage by expanding Medicaid access leads to numerous systemic benefits as well, including promoting the financial viability of hospitals and health systems by reducing emergency department visits and even bolstering state criminal justice systems by reducing recidivism and incarceration rates. There is also research showing that Medicaid expansion along with other social supports can  help to address the many unmet mental health and SUD needs of individuals experiencing homelessness. So not only does closing the coverage gap address individual treatment for SUD, but it broadly and positively impacts our neighborhoods and cities.

It’s great that the Governor has issued a proclamation, but we must ask ourselves and our lawmakers: What kind of North Carolina do we want to live in? A state that only supports its residents on paper or one that takes real action to provide meaningful access to health care to everyone so that we all — individuals, businesses and communities as a whole — can thrive? Clearly, North Carolina needs actual deeds to from state leaders to bring about such a reality.