Advocates, people in need demand closure of the Coverage Gap as Medicaid “reform” hearings commence

Medicaid expansionNorth Carolina’s Department of Health and Human Services has a busy few weeks ahead as it commences a series of public hearings around the state concerning its plan to privatize the state Medicaid program and obtain a waiver from the Federal government that would approve the scheme.

Yesterday, a large crowd attended the first public hearing session in Raleigh (click here to see the schedule and sign up to attend future public hearings). The hearing was attended by health care providers, administrators, advocates, current Medicaid enrollees, and individuals that would benefit from Medicaid expansion. Unfortunately, only two legislators, Rep. Marilyn Avila and Sen. Floyd McKissick Jr., were in attendance to hear what people have to say about reform.

One message that rang clear during yesterday’s event was that North Carolina cannot truly transform Medicaid without first expanding the program to the approximately 500,000 people in the Coverage Gap. At the hearing, roughly a third of all of the comments offered called for Medicaid expansion as has been done in so many other states under the terms of the Affordable Care Act. Speakers representing organizations such as the American Heart Association, Carolina Jews for Justice, the League of Women Voters, and even a student from NC Central University all spoke on behalf of the child care workers, construction workers, and home health aides that work, but are stuck in the gap.

Before opening the floor to public comment, DHHS Secretary Rick Brajer explained that he and his team have been “crowd sourcing the development of the waiver.” Brajer even presented a slide listing all of the key “stakeholders” that his department has met with during the preparation of the waiver request.

Unfortunately, one group that was clearly missing from the Secretary’s list were the people in the Coverage Gap. These voices need to continue to be heard as access to quality and affordable health care not only positively impacts individual and family health, but community health as well through job growth and economic development.

In the weeks ahead, look for more and more advocates and potential beneficiaries of expansion to speak out for this kind of genuine reform.

  • Providers will push for Medicaid expansion so that their patients will no longer have to rely on emergency care and actually be able to obtain primary preventative care.
  • Health administrator concerned with health care costs will push for expansion as states with expansion have seen a decrease of 26 percent in uncompensated care costs.
  • School teachers will push for expansion because they know that their students will have increased educational outcomes if their parents/caregivers receive Medicaid.
  • Business owners will push for expansion because good health is closely linked to job productivity .

For more information on how you can be a part of the effort to help push for Medicaid expansion and meaningful reform, click here to learn more about the hearings and here to submit comments online.

Debunking Medicaid expansion misperceptions

Despite reports from states that Medicaid expansion has had health and fiscal benefits, North Carolina remains in the minority along with 18 other states that have failed to close the coverage gap. Unfortunately, there is still a sentiment that people have to prove that they are deserving of health care coverage, instead of noting how increased access to health care and utilizing health services has positive effects ranging from school achievement to job production. The 2016 Child Health Report also highlights how parental coverage is directly connected to whether children have access to and utilize health care services .

Those who object to expanding Medicaid fail to report that many individuals in the coverage gap are working, but may not work enough hours to qualify for employer-sponsored health insurance. Further, many working adults in the coverage gap have low wage jobs and thus make too little to receive financial assistance to purchase health coverage through the Marketplace. As a family of four in the coverage gap has an income of $33,534, it does not seem that Large Health Savings Accounts (HSAs) are a viable option for families that have other financial priorities.

Failing to expand Medicaid will not only continue to increase health disparities among individuals and families, but also entire communities. The longer policymakers take to close the coverage gap, the more it impacts rural communities’ ability to provide affordable and quality health services. According to the Hospital Strength Index, there are 16 vulnerable rural hospitals in North Carolina. If these hospitals were to close, there would be over 300,000 fewer patient encounters and over 3,000 health care related jobs would be lost. Considering that nearly 30 counties in North Carolina lack primary care providers such as Ob-Gyns, the gap in availability of health services could increase further.

Opponents of closing the coverage gap also cite concerns that individuals that currently obtain financial assistance to purchase health insurance through the Marketplace will shift to “inferior” Medicaid coverage if North Carolina expands Medicaid. However, a report by The Commonwealth Fund, states that Medicaid beneficiaries receive preventative care at the same rate as those with private health insurance. Medicaid enrollees also reported similar rates of satisfaction with their health care experience as the privately insured. What’s more, Medicaid beneficiaries report having medical debt at lower rates than the privately insured. Along with the misperception that people will receive “inferior” care, there is concern there will be increased burden to individuals and families with private insurance through cost-shifting. Overall, Medicaid spending growth is less than private insurance. Additionally, as payment for private insurance and Medicaid services shift from fee-for-service to global payment models, cost-shifting to private insurance beneficiaries is unlikely. Considering that Medicaid reform is transforming to a full risk capitation payment model, this is even less of a concern in North Carolina. Now that North Carolina’s Medicaid program is entering a new phase, it is time to extend Medicaid coverage to 500,000 people in the coverage gap.

Tomorrow is National Youth Enrollment Day for the ACA

Despite policymakers’ attempts to repeal all or parts of the Affordable Care Act (ACA) nearly 60 times, the ACA works. Further, both times all or certain provisions of the ACA have been to the Supreme Court, the health care law has remained mostly intact. In 2014, the ACA enhanced the well-being of nearly 460,000 North Carolinians who were able to obtain affordable health care coverage. Open Enrollment 3 started on November 1, 2015 and goes until January 31, 2016. While many residents of the Tar Heel state understand the benefits of the ACA, only 28 percent of enrollees are young adults based on 2014 enrollment data. Tomorrow, January 21st, is National Youth Enrollment Day and advocates of the ACA are encouraging young adults to get covered.

Why should young adults enroll in the ACA?

  • Even though the ACA allows youth until age 26 years to remain on their parents’ insurance, adults between the ages of 19 and 34 years are still the most likely to be uninsured.
    • Many pediatricians will continue seeing patients until they complete secondary school and college or until 18 to 21 years. For many young adults, once they leave pediatric care, they do not have a regular primary care doctor until their 30s and 40s.
  • Young adults are the least likely to have a health care home. Individuals who do not have a regular place to seek health care are more likely to rely on urgent or emergency care.
  • You can shop the Marketplace to find a coverage plan that fits your budget. This is especially important because…
    • Young adults were the hardest hit by the Great Recession, thus increasing the need for financial help in obtaining care through the ACA;
    • The average amount of financial help North Carolinians receive is $315 per month;
    • The penalty for not obtaining health care coverage has increased to $695 per person or 2.5 percent of one’s household income, whichever is higher. For more information please visit: https://www.healthcare.gov/fees/fee-for-not-being-covered/ or call: 1-855-733-3711;
    • As of November 2015, 81 percent of ACA enrollees from NC selected plans that cost less than $75 per month.
  • Health care coverage offers one peace of mind…
    • No longer have to worry about whether you can access affordable or quality care when you need it;
    • No longer have to worry about waiting until a health concern becomes severe or chronic and thus more costly;
    • No longer have to worry about bankruptcy or the financial burden from medical bills if you or a loved one gets sick.
  • Affordable health coverage helps young adults access primary care preventative care…

There are 11 days left to enroll, please visit healthcare.gov to start the enrollment process!

An early start to your New Year’s resolutions: Get health coverage

Enroll America

Image: www.enrollamerica.org

Despite policymakers’ attempts to repeal all or parts of the Affordable Care Act (ACA) nearly 60 times, the ACA works. What’s more, the law is clearly here to stay. On both occasions that all or specific provisions of the ACA have been to the Supreme Court, the health care law has remained largely intact. In 2014, the ACA enhanced the well-being of nearly 460,000 North Carolinians who were able to obtain affordable health care coverage.

Now, it’s time once again for the uninsured to enroll. Open Enrollment 3 started on November 1 and goes until January 31, 2016. As of December 5, nearly 200,000 people in North Carolina had applied for health care coverage through the Marketplace. Today, December 15, is the deadline to enroll for health coverage starting on January 1, 2016.

Even though there has been much attention paid to increasing premiums for coverage purchased through the Marketplace, many North Carolinians will still receive financial help. The average amount of financial assistance received by ACA enrollees is $315 per month. Further, the majority of enrollees selected plans costing less than $75 per month.

Another fiscal consideration is that the penalty for not enrolling in a plan is increasing to $695 per person or 2.5 percent of one’s household income, whichever is higher. 2016 will also be the first year that people will not receive an additional grace period or special enrollment period around the tax deadline. Even though the financial impact of obtaining health coverage is significant for many households and individuals, having access to health care gives one peace of mind. The ACA mandates the coverage of essential health benefits ranging from maternity and newborn care to mental health and substance use disorder treatment.

Unfortunately, hundreds of thousands of North Carolinians will not qualify for health coverage through the ACA, do not have access to employer based health insurance, and are ineligible for Medicaid. Our state policymakers have failed to extend health coverage through Medicaid expansion to home health care workers, parents, office clerks, and school bus drivers.

One year ago, the Cone Health Foundation released a report highlighting the benefits of Medicaid expansion. If our state legislators would have chosen to expand Medicaid, 29,000 jobs would have been created this year. In addition to the approximately 200,000 (and counting) North Carolinians who will have health coverage starting in the new year by enrolling in the ACA, according to the report 300,000 people would have gained health coverage if policymakers had decided to expand Medicaid this year. Let’s start 2016 on a healthy note, enroll for health coverage today and encourage your state policymakers to expand Medicaid to 500,000 North Carolinians in the coverage gap.

Honor our veterans with health care

VetHealthNorth Carolina ranks 8th for veteran population as there are nearly 800,000 veterans living in the Tar Heel state. The VA reports that in 2014 there were four VA Hospitals, six Vet Centers, and sixteen community-based outpatient clinics throughout the state. Given the veteran population, it is easy to see why the VA Secretary, Robert McDonald, has reported much difficulty in meeting demands for veteran health care with limited resources and facilities. In North Carolina, only 321,459 veterans are enrolled in the VA Health Care System and only 214,215 patients were reported as treated in North Carolina in 2014.

Further, 316,000 veterans are aged 65 years and over and thus qualify for Medicare, which makes it easier to access health care outside of the VA Health Care System. Unfortunately, there are too many veterans that have difficulty accessing care and with statistics showing that one out of every ten veterans under age 65 years do not use VA health care and do not have health insurance shows that the United States has much room to improve how we care for those who have served this country. Fortunately, with the passage of the Affordable Care Act (ACA), a pathway did open to make health care to veterans more affordable and accessible. The pathway is Medicaid Expansion. Research has shown that four out of every ten uninsured veterans fall into the Medicaid coverage gap. This means that many veterans and their spouses make too much money to qualify for Medicaid (note: there are additional criteria for Medicaid eligibility) and too little to qualify for financial help or subsidies to enroll in the ACA through the Marketplace.

A report by the Robert Wood Johnson Foundation that used data from the 2008-2010 American Community Survey, show that there are approximate 23,000 veterans in North Carolina that would benefit from Medicaid Expansion. Approximately, 8,000 spouses of veterans would also be able to access affordable health care if North Carolina expands Medicaid. So as we honor those who have fought and served our country tomorrow, let’s not forget that North Carolina has an opportunity to protect our veterans and their families’ health by closing the coverage gap. As Medicaid reform moves forward, our policymakers can include Medicaid expansion so that veterans’ mental and physical health is protected.