News, public health

Remembering a voice who spoke for those in dire need of healthcare

Dr. Charles van der Horst

On Tuesday, friends and family gathered at Beth El Synagogue in Durham to honor the life and legacy of Dr. Charles van der Horst.

Van der Horst, who died unexpectedly over the weekend in a swimming accident in New York, was a prominent voice for the uninsured and for Medicaid expansion in North Carolina.

The Raleigh News & Observer noted his career spanned decades and made a lasting impact:

Van der Horst was a preeminent UNC researcher and clinician who helped develop groundbreaking treatment protocols for HIV/AIDS and, after that once-terrifying virus had been tamed to a manageable disease, inspired a new generation of scientists to tackle Ebola. He was a compassionate doctor who turned a community service stint into a campaign to eradicate Hepatitis C in Wake County. He was a social justice advocate willing to go to jail to draw attention to the needs of the state’s uninsured.

NC Policy Watch got to know van der Horst in that last role, as a social justice advocate.

In 2017, he appeared on Policy Watch’s News & Views to discuss the wrongheaded approach by Republicans in Washington to gut the Affordable Care Act. Here’s an excerpt of that interview:

Governor Roy Cooper also remembered the doctor this week on Facebook: “Dr. Charlie Van Der Horst’s life and work were defined by compassion. From his time volunteering in North Carolina’s free clinics to his efforts on the front lines of the HIV/AIDS epidemic, he made our state and our world better.”

Van der Horst was 67.

Governor Roy Cooper, News, public health

At Opioid Summit, experts call for Medicaid expansion

A new “Opioid Action Plan 2.0” unveiled Wednesday by North Carolina officials aims to combat the lingering narcotic crisis with new, youth-targeted programs, tougher laws and greater access to the drug naloxone, used to treat or reverse opioid overdoses.

“I’m going to work with all of you to make sure that we reduce opioid deaths in North Carolina and that we meet this problem head on,” said Governor Roy Cooper at the opening of the 2019 Opioid Misuse and Overdose Prevention Summit, a conference supported by the North Carolina Department of Health and Human Services (DHHS).

The updated plan uses “feedback from partners and stakeholders,” according to a press release by the Governor’s Office.

The original N.C. Opioid Action Plan, released in 2017, identified the steps that the DHHS aimed to take in order to reduce the number of deaths from the opioid epidemic.

Officials introduced the new plan during the second and final day of the Opioid Summit.

At the opening of the summit Tuesday, Cooper highlighted the progress made since the plan was launched. According to Cooper, since 2017, the number of prescriptions for opioids has decreased by 24 percent and the number of emergency department visits for opioid overdoses decreased by nearly 10 percent from 2017 to 2018.

But the most important step, according to the DHHS? Medicaid expansion.

“We need to close the coverage gap if we are to make serious headway against this epidemic, as they have done in other states,” said Dr. Mandy Cohen, Secretary of the NC DHHS.

Numerous studies have shown that expanding Medicaid and closing the coverage gap has led to a decline in opioid overdoses by increasing substance use disorder treatment. According to the Opioid Action Plan 2.0, an estimated 89 percent of people who are in need of substance use disorder treatment do not receive it.

“The progress we’ve made shows what we can achieve when we partner across agencies and organizations and with those on the ground in communities,” said Cohen in a press release. “But there is much more to do. Moving forward we need to work even harder to focus on prevention, reduce harm and connect people to care.”

News, public health

UNC/Vidant Health conflict headed to Senate committee

Update: Meeting in an emergency session late Monday, the Pitt County Board of Commissioners approved a proposal to end the dispute between Vidant Health, the county and the UNC System.

Under the proposal the UNC Board of Governors would appoint four members to the hospital’s board rather than the nine it appointed under the original agreement. Pitt County would retain its 11 appointments (at least one a physician from Pitt County) and the Vidant board would itself appoint two members (both physicians from ECU nominated by a committee at the university). The dean of ECU’s medical school would also hold a seat on the board.

UNC rejected the proposal in a statement, insisting that the system in place since the 1970s agreement between the parties be restored.

“We continue to believe that the best path forward for Vidant, Pitt County and East Carolina University would be to honor the long-standing partnership that has served eastern North Carolina well for more than 40 years and to fully restore the governance structure all parties had agreed to in the affiliation agreement,” the UNC System statement read. “We welcome future dialogue with Vidant leadership and look forward to hearing their concerns, as well as resolving problems that have arisen in the relationship with Vidant and its support of the Brody School of Medicine.”

Members of the committee said they weren’t sure whether that discussion would go forward as the parties are now in mediation.

Tensions between UNC and the eight hospital system based in Greenville exploded last month after Vidant announced it was no longer acknowledging the UNC Board of Governors’s right to appointment members to the the board of Vidant Medical Center.

Under an agreement in place since the 1970s the UNC Board of Governors appoints nine members to the board, part of its serving as a teaching hospital for ECU’s Brody School of Medicine. The Pitt County Board of Commissioners, whose county once owned the hospital, appoints 11.

ECU and the UNC system sued to prevent losing those appointments, the court issued a temporary restraining order freezing the current relationship in place and the parties have now entered into mediation.

Last week the UNC system issued a statement on the struggle through UNC Spokesman Josh Ellis.

“We continue to believe that the best path forward for Vidant, Pitt County and East Carolina University would be to honor the long-standing partnership that has served eastern North Carolina well for more than 40 years and to fully restore the governance structure all parties had agreed to in the affiliation agreement,” the statement read. “We look forward to hearing Vidant’s concerns, as well as resolving problems that have arisen in the relationship between with Vidantand its support of the Brody School of Medicine.”

But Vidant leaders in Greenville say the conflict goes deeper. Last week Greenville TV news station WITN released confidential documents from a consulting firm hired by the UNC system that showed their research into taking over the system.

In response Vidant released a statement accusing the UNC system of a “behind the scenes” plan to take over Vidant.

“It is part of a coordinated effort by outside interests and Raleigh politicians to take dominant position in governance, deal terms, etc. in eastern North Carolina,” the statement said.

“Despite this and many false narratives, the affiliation agreement with the Brody School of Medicine has always been and continues to be in effect,” Vidant said in its statement. “In fact, Vidant continues to support the education of medical students, residents and other health care providers, including Pirate nurses. The significant financial support from Vidant to Brody continues.”

UNC responded with a statement denying they had any plan — secret or otherwise — to take over the system.

“Even if there were plans, secrecy would be impossible,” the system said in a statement. “A combination of UNC Health Care and Vidant Health would require the approval of multiple public entities and boards. It would also require a public bidding process under State law.”

“Like all hospital systems, the UNC Health Care System is keenly aware of the rapid consolidation occurring across the country,” the statement read. “All systems look frequently to consider potential partners. The leaked document was prepared by a consulting firm hired by the UNC Board of Governors to illustrate and educate them on what the consolidating health care market might look like in the future. It was not prepared to evaluate partners or to pursue new partners.”

UNC Health Care has had a number of conversations with Vidant CEO Mike Waldrum about working together better, the system said in the statement, but none about takeovers. The statement alleges that Waldrum has talked with the UNC system and members of the Board of Governors in the past about the possibility of merging with UNC Health Care, which until recently was headed by Bill Roper, now interim president of the UNC System. UNC Health Care did not pursue the idea, the statement said.

The Senate budget, passed last week, would cut $35 million in Medicaid funds from Vidant Medical Center, an outcome both Republican and Democratic Senators said they would like to prevent.

Waldrum told Greenville’s Daily Reflector newspaper he didn’t understand why the budget cuts were put in place as the two parties were trying to resolve their disagreement.

““We think they have some valid concerns but we want to make sure our concerns are heard and we are committed to working with them through the process,” Waldrum said. “That’s why the thing we don’t understand is these cuts were put in the budget at the same time the two legal teams were working to resolve the issues.”

“We had hoped that we made appropriate and best-governance changes (and) they would work with us,” he said said. “We did not anticipate people would take actions that would damage eastern North Carolina. We were surprised by that.”

Senate leader Phil Berger said Monday that “all potential options” are being considered to resolve the dispute.

News, public health

As measles cases reach a new high, NC medical providers urge vaccine-skeptics to immunize their children

For those keeping a tally, 60 new measles cases cropped up in the U.S. last week. That brings the total number of cases to 940 this year.

Health officials say confirmed cases have been reported in more than half the states and we are now experiencing the worst outbreak in 25 years.

The continuing spread has health officials worried ahead of a busy summer travel season.

If you missed it over the holiday weekend, be sure to listen to our interview (click below) with NC Health News reporter Reporter Sarah Ovaska-Few, who talks with Policy Watch about the increase in measles outbreaks and what North Carolina pediatricians are doing about the drop in vaccination rates.

And for more from Ovaska-Few, check out her latest story at NC Health News on the ongoing court challenges to the DHHS’ choices for Medicaid managed care providers, which threatens to derail more than than $30 billion in contracts.

Commentary, public health

N.C. House budget underestimates funding needed for Medicaid

Budgeting for anticipated expenses is a key element to fiscal responsibility, just as ensuring that the tax code is adequate to meet those expenses and the needs in communities.

Unfortunately, the N.C. House of Representatives’ budget has failed to pursue this approach in the area of providing quality, affordable health insurance to low-income North Carolinians with disabilities, the elderly, children, and pregnant women.

The budget proposal they approved earlier this month introduced a Medicaid rebase nearly $40 million lower than the Governor’s budget. It also includes a management flexibility cut of $15 million that may result in the need for reductions in administrative oversight at a critical moment in the transformation of the Medicaid system in our state. Last year, the General Assembly underfunded the rebase by nearly $28 million.

While rebase adjustments are only cost estimates based on anticipated changes to enrollment, utilization, costs, rates, and more, there is no advantage to underestimating these costs and, in fact, it compromises the budget process altogether by failing to show the true expenses the state should be meeting.

In years past, inadequate rebase allocations have meant that the General Assembly has to come up with funds at a later date in order to make up the difference, leading to challenges when balancing the state’s budget with available revenue. This is because Medicaid is an entitlement program, meaning that people who apply and meet eligibility criteria are entitled to receive services.

November will also mark the start of North Carolina’s shift to Medicaid managed care, which will involve paying private insurance companies on a per member per month basis to manage the physical and behavioral health needs of those enrollees. While the thinking is that Medicaid transformation will create savings for the state, this expected net savings will take place over time, and it would therefore be prudent for state lawmakers to carefully allocate funds to this area.

Of course, there are also limitations in the state budget thanks to tax cuts introduced since 2013, which have severely limited North Carolina’s ability to generate revenue and invest in our state.

This year alone, the tax cuts that took effect in January resulted in $900 million loss to expected revenue for the upcoming fiscal year, and a current proposal in the Senate would be another blow to the state’s dwindling revenue, worsening the structural deficit.

Suzy Khachaturyan is a Policy Analyst at the Budget and Tax Center, a project of the North Carolina Justice Center.