No more baby steps: It’s past time for full Medicaid expansion

The landmark Affordable Care Act (ACA) is still young at ten and a half years old and it has been challenged and bullied by conservative politicians across the country. Today, however, it’s clear that the law is here to stay and that many of those same politicians who opposed it now realize how much the ACA has to offer and have fully accepted it. Indeed, one state after another — 38 at this point — has accepted Medicaid expansion after it was made voluntary by the Supreme Court.

North Carolina, however, continues to miss the opportunity. As we miss out on this chance to bring health care to hundreds of thousands of North Carolinians, families across our state are forced to miss out on moments with loved ones lost to the coverage gap.

People like Robin, whose daughter Jessica died from an accidental overdose after not being able to get help for her mental health and substance use disorder issues due to being in the gap.

People like Margie, who lost her brother-in-law Jeff to cancer that was diagnosed too late, because he didn’t have insurance through his job as a cook and wasn’t eligible for Medicaid.

People like those in Deanna’s family, who lost their matriarch because her cervical cancer went undetected, after she lost pregnancy Medicaid coverage when her son was stillborn.

Even in the midst of a health pandemic, state leaders have refused to expand Medicaid — either during the General Assembly’s special COVID-19 sessions or the current “long session.” This has been despite the presence of daily opportunities to pass a bill or include it in the budget that just became law.

This year, it seemed that we were closer than ever before. I was looking forward to sharing the news with Robin and Margie and Deanna’s family that our state’s leaders were finally going to close the Medicaid coverage gap for well over 600,000 Tar Heels.

Ultimately, however, Medicaid expansion — something that, during a pandemic, has saved lives and strengthened communities in expansion states and that would have been accompanied by a minimum $1.7 billion incentive from Congress — has been excluded from the state budget. This critical lifesaving policy that not only connects people to preventative care screenings, helps them fill their prescription medications, and is also a lifeline for rural hospitals, has once again been denied.

Instead, the final budget features an array of missed opportunities and ultimately, a failure to invest and fully support all people and communities, including the same essential workers who’ve been celebrated by the entire state as heroes, but who often don’t receive the compensation and benefits they deserve.

Indeed, in addition to its truck-sized shortcoming when it comes to health care, the new budget also fails to provide full funding for public education that is required by our state constitution (and a court order) or to ensure that wealthy corporations pay their fair share in taxes for the public good.

Sadly, all that I have to share with Robin, Margie and Deanna’s family is that instead of fully expanding Medicaid, lawmakers approved temporary access to care for new mothers and for foster parents to assist with reuniting families. These are mere baby steps that leave us miles still to travel to achieve genuine and truly meaningful Medicaid expansion.

Are there provisions in the budget that will improve lives? Sure. But, there’s nothing about this budget that changes the fact that hundreds of thousands of our friends, neighbors, and small business owners are still stuck in the coverage gap awaiting rescue. Cutting taxes on wealthy corporations will not help us strengthen our communities now or over the long term. People who are the most impacted by poverty should always be at the center of policymaking. The months-long budget process had ample time for public comment, yet the process was shrouded in secrecy and carried on behind closed doors.

Public comment would have revealed what we already know: North Carolinians overwhelmingly agree with Medicaid expansion policy. The state’s deadly coverage gap has now persisted for a decade. It’s been tough for too many far too long.

Advocates for expansion are not, however, giving up. Ultimately, all North Carolinians are in this together so even though this year’s budget doesn’t include Medicaid expansion, we’ll look towards the legislative committee appointed by the General Assembly to get it done next year, once and for all.

Nicole Dozier is the Director of the North Carolina Justice Center’s Health Advocacy Project.

It’s past time for the president to stop sabotaging the ACA

Even though efforts to repeal the Affordable Care Act outright appear to be dead for now, President Trump, in keeping with his misleading “promise” to let the law “fail on its own,” continues to work to sabotage it.

This effort has been aided by cynical proposals in congress — including an “American Health Care Act” that was actually quite un-American, a “Better Care Reconciliation Act” that wouldn’t have provided any better care and a so-called “skinny repeal” that was really just feeble and anemic.

And now, even though some members of Congress have started working in a bipartisan manner to improve health care delivery and stabilize the market, Trump is again working to sow confusion and fear. As Labor Day weekend approached, the administration announced that despite the amazing success of the ACA Navigator Program in helping more than nine million Americans become insured, it would be cutting funding by 40 percent. Funding for local Navigators will now be based on their success in meeting previous year enrollment goals–goals that are likely to have been unmet due to the Trump administration’s previous action to slash the outreach and marketing budgets during the last ACA open enrollment period.

So, if a local program achieved 100 percent of its goals, it gets the same level of funding. If 70 percent, then it  gets 70 percent funding. If 40 percent then, yes, 40 percent funding. This “performance based” measure fails to take into account that it’s likely in the fifth year there are people who select to be auto-enrolled.

During Open Enrollment Four (OE4) 549,158 North Carolinians enrolled in private plans through the Marketplace, an impressive fourth place behind California, Florida and Texas.

Once again, however, instead of celebrating gains through the ACA and working on policies to move Americans forward, the Trump administration is busy looking backward to find more ways to sabotage an incredibly successful public initiative established by his predecessor.

The bottom line: Public opinion polls show that people want, by sizable margins, to improve the ACA. With repeal now “off the table,” we need policymakers — the President included — to listen to their constituents and to pull up their chairs and get to work on making the law work even better for everyone.

How we ought to honor mothers this weekend

As a mother and also a daughter, each year I try to think of something unique that will celebrate my deserving mother and friend. As a health care advocate engaging communities and policymakers, today I’m thinking of the mothers in our state who have serious health care access and coverage concerns.

This week in Greenville, I listened to a mother explain how health coverage and services through Medicaid provide care to her daughter with special needs. Medicaid is a “life support” to their family, enabling her to work. I also heard one daughter’s story about her mother’s ineligibility for Medicaid, as her income falls a few thousand dollars over the limit, and how being uninsured has had devastating consequences for her health.

Last week, the U.S. House voted for the American Health Care Act (aka “Trumpcare”), a bill that would snatch away coverage, benefits, and protections from Americans and revive discriminatory health insurance practices. Among many others, this bill dishonors mothers.

I regularly meet mothers who earn low to moderate incomes as professional caregivers so the rest of us can enjoy peace of mind knowing that our children and our elderly are receiving quality care.

For these caregivers and other hard workers who’ve fallen into the Medicaid Coverage Gap, we can close the gap. Medicaid coverage provides essential health care services for women of all ages, from maternity care that promotes maternal and child health, to long-term care services for older adults and people with disabilities. In addition, children who access regular health care typically realize better long-term health and academic and career achievement.

As we celebrate Mother’s Day this weekend, let’s work together to honor mothers with expanding access through coverage for all.

Message to Trump administration: Protect our care; don’t weaken the Marketplace

You don’t have to be low-income or uninsured to grasp how challenging and complex the modern world of health care and health insurance has become. Even in my role as a fully insured professional who works in the field every day as an advocate, I wrestle with the challenges the system presents — especially when I grapple with the health concerns of my teenage children and retired parents. The Affordable Care Act has certainly improved things, but we clearly have a long way to go.

In such an environment — one that challenges even informed and comparatively well-off people — it’s remarkable and outrageous that the Trump administration released a proposed health care rule yesterday that would make it harder to for people to remain covered. This proposal — which comes just one day after many North Carolinians celebrated the value of Affordable Care Act at various #HaveAHeart events throughout the state — shows that opponents of the ACA in Congress and the Trump administration value the short-term bottom lines of insurance companies over citizens that elected them into office.

The proposed rule would increase premiums and out-of-pocket costs for consumers while reducing financial help (i.e. tax credits) and plan offerings. It would also shrink the open enrollment period from three months to less than two — a change favored by some insurance companies which complain that people sometimes enroll toward the end of open enrollment period to pay for upcoming costly services only to drop coverage soon after. Instead of viewing the late sign-up as an economic issue for consumers, it seems insurers and the Trump administration believe there are people who actually plan in advance to develop a health condition, suffer a trauma or even receive news of a serious diagnosis after a preventive screening only to drop it and not continue future care.

Another provision on the table provides that regardless of health status, insurers can decide to refuse coverage to individuals or employers who have unpaid premiums. Such a policy would be sure to produce devastating effects in the form of delayed care and worse health outcomes (even death) for families dealing with significant economic and medical needs. It would also increase long-run costs as earlier, lower-cost interventions give way to later, higher-cost treatments. Sadly, the Trump administration seems determined to address the concerns of the insurance industry by shifting all of the burden onto the backs of millions of average Americans.

It shouldn’t (and doesn’t have) to be this way. Instead of higher costs and greater uncertainty, Americans should instead be assured they can have health coverage to access the care they need, when they need it, free from discrimination. Insurers should have a place in a stable, strong Market free from provisions that encourage collapse. What’s more, insurance companies should do what they usually do best — look at the long term — and join with consumers to push for such a win-win outcome.

Right now, individuals, providers, public officials and other leaders across the country are pushing back against the Trump proposals. Let’s hope insurance companies — many of which are among the leading corporate citizens in North Carolina and elsewhere — begin to look beyond their own narrow, short-term interests and join in this effort.

Medicaid expansion will be on the front burner at Women’s Advocacy Day tomorrow

Nicole and LindaTomorrow is Women’s Advocacy Day at the North Carolina General Assembly and there are a lot of good reasons for caring women (and men) to attend. The one at the top of my list will be Medicaid expansion – the long-neglected plan to extend decent, affordable health coverage to hundreds of thousands of North Carolinians.

As has been explained repeatedly in countless places in recent months, North Carolina would benefit greatly from Medicaid expansion. The numbers of lives that would be saved and the amount of money that would flow to the state are both huge and more than reason enough for state leaders to act. As a group that has long endured lower pay and benefits, women would also benefit disproportionately from expansion.

For me, however, the motivation for speaking out goes well beyond the numbers. It’s also about speaking out on behalf of people who I know and care about – people like my friend, Linda Dunn (that’s us on the left at the General Assembly last month).

I met Linda back in December at a community forum in Kinston at which Sen. Don Davis, Lenoir County Sheriff Ronnie Ingram and several other community leaders expressed concern about the failure to expand Medicaid and the fact that, in Lenoir County alone, expansion would cover 2,270 residents and create more than 350 desperately needed jobs.

Linda attended the forum along with her adult daughter. I met them just before the discussion was set to begin. She was terribly concerned about her daughter’s lack of access to insurance and medical care.

In fact, she was so concerned that she was later inspired to travel to Raleigh to share her family’s story during last month’s Medicaid Expansion Advocacy Day. Linda held onto the podium in the Legislative Building press room while some in the audience held back tears as she spoke like only a mother could about the devastating impacts of suffering from chronic health conditions without insurance. Read more