NC Budget and Tax Center, public health

Medicaid and Medicare mark 53rd anniversary by continuing to serve millions of North Carolinians today

Medicaid and Medicare were signed into law on July 30, 1965 – exactly 53 years ago this week.

President Lyndon Johnson signs the Medicare and Medicaid Bill (July 30, 1965). LBJ Library photo

Since these programs were created, they have given millions of people access to a doctor so they can maintain their health. Over the long-term, these programs have provided significant returns on investment, such as benefiting children into adulthood by lowering disability rates and increasing their earning income potential. Today, these two healthcare programs are worth celebrating and expanding even further as they continue to serve millions of Americans and North Carolinians each day.

In North Carolina, 2.3 million people receive comprehensive, affordable health coverage through Medicaid. Medicaid provides health coverage to low-income families and individuals, including children, parents, pregnant women, seniors, and people with disabilities. Meanwhile, 1.8 million North Carolinians (18 percent of the population) are served by Medicare, which serves people over 65, younger people with disabilities, and dialysis patients.

At a time when some lawmakers in Congress and in our state’s General Assembly minimize the value of these critical healthcare programs and limit their potential, it is important to celebrate the 53rd anniversary of Medicaid and Medicare and recognize that their continued evolvement have helped transform the lives of millions of people in positive ways. In recognition of their 53rd anniversary, here are five facts and three charts that provide a quick glimpse into their reach, structure and impact.

Fact 1: North Carolina’s health insurance gap coverage gap needs to be closed: In 2016, North Carolina had the 9th-highest uninsured rate (16.2%) in the nation for ages 18-64. This is above the national average of 12.4 percent.

Fact 2: North Carolina’s legislature has rejected Medicaid expansion since 2013: If North Carolina expands Medicaid, over 600,000 more people in the state would receive healthcare coverage and $4 billion would be added to our state’s economy annually.

Fact 3: Medicaid is funded jointly by the federal government and the states: In North Carolina, the federal government pays for 66 percent of Medicaid’s costs, and the state pays the remaining 34 percent, resulting in a 2:1 federal “match.”

Fact 4: The Medicaid system is efficient: For every dollar spent on Medicaid, 94 cents is spent directly on health services. Furthermore, Medicaid’s costs increased at about one-fourth the rate of private insurance since 2007.

Fact 5: Women comprise 55 percent of Medicare beneficiaries in North Carolina: The average age of a Medicare beneficiary in our state is 71. In 2016, 1.5 million seniors and 321,600 people with disabilities in North Carolina were Medicare beneficiaries.

Luis A. Toledo is a Public Policy Analyst for the Budget & Tax Center, a project of the North Carolina Justice Center.

 

public health

Trump Administration reverses decision to freeze insurer payments, undermining ACA coverage

Just weeks after the Trump administration announced it would suspend a program that helps health insurers cover the costs of high-risk enrollees, the Centers for Medicare and Medicaid Services said it had adopted language that will now allow the agency to distribute more than $10 billion from a “risk adjustment” pool.

The national, nonpartisan Families USA said Wednesday it was relieved the Trump administration had reversed “its ill-conceived decision” to stop the risk adjustment payments, which help insurers cover people with pre-existing conditions.

While the risk adjustment program costs the government nothing, it is vital to the functioning of the market for people who buy coverage on their own because it facilitates the pooling of risk, keeping costs stable for consumers, including people with pre-existing conditions.

“The risk adjustment program prevents health insurance plans that happen to get a larger share of high-cost enrollees than other plans from being at a financial disadvantage. Without risk adjustment in place, plans will have a strong financial incentive to cherry-pick patients who cost less to insure and put up as many barriers as possible for people with preexisting conditions and others with high health care costs.

The New York Times explains the reversal was driven by both nervous Republicans and insurers:

If payments are not made, it said, “there is a serious risk” that insurers will substantially increase premiums in 2019 to make up for the loss. The higher premiums could make coverage unaffordable for some consumers, especially those who do not qualify for subsidies, it said.

Insurers are now deciding whether to participate in the marketplace in 2019 and setting the rates and benefits of the plans they intend to offer next year.

Republicans in Congress, afraid of being blamed in the midterm elections this year for even higher premiums, had urged the Trump administration to resume the payments to insurers.

Read the full NYT article here.

Blue Cross Blue Shield of North Carolina is expected to file its rate request for 2019 later this summer.

Commentary, public health, Trump Administration

Another act of health care sabotage over the weekend from the Trump administration

Donald Trump speaking

President Donald Trump

On Saturday, the Trump administration announced it would temporarily suspend a program that helps health insurers in the individual market cover the costs of high-risk enrollees, injecting uncertainty into the health insurance markets that could lead to higher premiums and fewer insurers offering coverage.

Sound familiar? It should, as it’s just the latest of many Trump administration efforts to sabotage the Affordable Care Act (ACA), including a similar effort from last October when the Trump administration abruptly cut off reimbursement payments to health insurers for subsidies they provide to consumers with low incomes. That action caused North Carolinians to pay a premium hike of 14.1 percent for Blue Cross Blue Shield of NC plans this year.

The insurance industry is already sounding the alarm about this decision. America’s Health Insurance Plans (AHIP) released a statement shortly after the announcement highlighting the sabotage effect:

We are very discouraged by the new market disruption brought about by the decision to freeze risk adjustment payments. This decision comes at a critical time when insurance providers are developing premiums for 2019 and states are reviewing rates. This decision will have serious consequences for millions of consumers who get their coverage through small businesses or buy coverage on their own. It will create more market uncertainty and increase premiums for many health plans – putting a heavier burden on small businesses and consumers, and reducing coverage options. And costs for taxpayers will rise as the federal government spends more on premium subsidies.

After all, suspending the Risk Adjustment program means insurers who cover sicker enrollees are missing out on billions of dollars they are owed under the law, and if the fund transfers aren’t restored, it’s likely consumers who will pay the price.

Risk adjustment programs—which enjoy bipartisan support in programs like Medicare Part D and Medicare Advantage—exist in order to maintain a functioning health insurance market in which insurers cannot discriminate against people with pre-existing conditions. The ACA’s Risk Adjustment program requires insurance companies that enroll relatively healthier populations to transfer funds to companies who enrolled older, sicker, and higher-risk enrollees, creating a disincentive for insurers to game the system (to the extent they can under the ACA) in an effort to avoid covering high risk patients.

The administration cites a months-old U.S. District Court decision for its announcement, but legal analysts have already poked holes in the government’s case. University of Michigan law professor Nicholas Bagley writes:

CMS says that the ruling “prevents [the agency] from making further collections or payments under the risk adjustment program, including amounts for the 2017 benefit year, until the litigation is resolved.” That’s wrong. The truth is that the Trump administration has lots of options. It’s just choosing not to exercise them.

Like in other issue arenas, the Trump administration has manufactured a crisis that will harm North Carolinians, and in a continued demonstration of bad faith, it’s refusing to govern effectively.

News, public health

North Carolina advocates, health care leaders press again for Medicaid expansion

N.C. DHHS Secretary Mandy Cohen speaks on Medicaid expansion Tuesday in Raleigh (Photo taken by Phyllis Nunn).

Roughly five years after North Carolina lawmakers dismissed calls to join a federally-backed program that would have extended health care access to an estimated 500,000 low-income residents, advocates are making their case to take up the program again with the N.C. General Assembly.

“All of that uncertainty about the Affordable Care Act (ACA) is past us,” N.C. Department of Health and Human Services Secretary Mandy Cohen told supporters Tuesday, as they prepared to converge on the state legislature to press for Medicaid expansion.

“In fact, we’ve never seen more support from the Republican side of the aisle for the Medicaid program,” Cohen added.

Constitutional amendments are expected to dominate the legislative discourse during the final days of the short session, but Tuesday’s advocacy day centered on North Carolina’s myriad health care woes, and Republican legislators’ refusal to opt into the ACA’s Medicaid expansion.

GOP critics worry the expansion, which would require the state to foot the bill for 10 percent of costs, comes laden with unpredictability, despite arguments to the contrary.

Indeed, a report this year from a Wake Forest University law professor and health care expert detailed emerging evidence that costs in the 34 states that bought into Medicaid expansion have not been so erratic after all.

Backers like Cohen—an ex-federal government healthcare administrator under former President Obama who was named to the state DHHS post last year by Gov. Roy Cooper—rebuffed GOP arguments again Tuesday.

“In North Carolina, (Medicaid) has been under budget for seven years now,” said Cohen. “No one can say ‘the program’s out of control, there’s no predictability in their budget.’ Nope.”

Cohen said Tuesday that Medicaid expansion would help to close the gap for poor North Carolinians who make too much to qualify for the government health insurance program.

Cohen also estimated that the program would create more than 40,000 new jobs in the state and generate billions of dollars in new economic activity.

She pointed to other Republican-led states like Indiana, Ohio and Michigan that saw similar results after agreeing to expand Medicaid.

“This does not have to be a political issue,” Cohen said. “This is just about common sense and being pragmatic.”

Tuesday’s advocacy day was also expected to include meetings with state lawmakers, an afternoon press conference and more. It was organized by a coalition of health care advocacy nonprofits, including the progressive N.C. Justice Center’s Health Advocacy Project. [Disclosure: The Justice Center is the parent nonprofit for Policy Watch.]

Meanwhile, Cohen huddled Tuesday with two North Carolinians who say the state’s refusal to expand the health care program cut them off from vital care and medicine.

N.C. DHHS Secretary Mandy Cohen (right) speaks to Burlington resident Marta Concepcion Tuesday about Medicaid expansion. (Photo taken by Billy Ball)

“It’s just really hard that I have to be in pain and I can’t get no help,” said Marta Concepcion, a Burlington resident who said she lost her government health care assistance when she moved from New York to North Carolina in recent years.

Concepcion said she’s been diagnosed with a heart condition, sleep apnea, high blood pressure, depression and bipolar disorder, but she can’t afford medication or regular visits with a doctor.

Concepcion tearfully recalled one recent doctor’s visit where she was told that she needed a more thorough examination by medical professionals.

“She goes to me, ‘you need to get checked, because we see something wrong with you, but it’s going to cost $100.’ Well, lady, you might as well say that I came here to die, because I don’t have that money.”

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Environment, public health

BREAKING: DHHS investigating suspected cancer cluster near Lake Norman

Zip Code 28117, one of two areas that have reported statistically higher than average incidences of thyroid cancer.

This is a developing story. Policy Watch will run a full story, including interviews with scientists and community residents tomorrow.

Two areas near Lake Norman have reported statistically higher than expected incidences of thyroid cancer, according to a May 29 letter obtained Tuesday by Policy Watch from the state Department of Health and Human Services.

Most of the cases occurred in two Zip Codes: 28115 and 28117.  The state undertook the analysis because of community reports of thyroid cancer, including several cases involving teenage girls.

Thyroid cancer is unusual in young people. It more commonly affects women in their 40s and 50s.

In preparing the assessment, the state’s Central Cancer Registry and the Division of Public Health concluded that from 1995 to 2016 the observed number of thyroid cancer cases in the 28115 Zip Code was two times the expected number.

In the 28117 Zip Code, the observed number was more than double over the same time period, and three times higher from 2012 to 2016.

Overall, Iredell County reported statistically higher rates of thyroid cancer: 1.5 times from 1995 to 2016, and more recently, 1.7 times from 2012 to 2016.

Zip Code 28115

“This investigation cannot be used to determine the cause of the observed cancers or identify possible associations with any risk factors,” the letter read. “It is important to note that the data and statistical analysis conducted at this step cannot determine if cancers observed in the community are associated with specific environmental, lifestyle, or other risk factors.”

Genetics and/or environmental exposure can increase a person’s risk for thyroid cancer. Exposure to radiation, flame retardants and perfluorinated compounds, such as GenX and PFOAs, can also enhance the risk. These compounds have been found in the Cape Fear River, a result of discharges and emissions from the Chemours plant near Fayetteville.

However, they also been detected at low levels in Lake Michie, in northern Durham County; since no industry discharges into the lake, Durham water officials believe the compounds are entering the water from the air.

Duke Energy built Lake Norman in the late 1950s and early 1960s. The utility’s McGuire nuclear power plant sits on the southern end of the lake; the Marshall Steam Station, a coal-fired power plant is also located on the lake, directly west of Mooresville.

The Occupational and Environmental Epidemiology Branch will review the data and determine the next steps, which will include reviewing the literature for environmental exposures associated with thyroid cancer risk, a DHHS spokeswoman told Policy Watch. “These steps will be completed with input from the community and others who have been involved in bringing attention to this issue. Information gathered will help inform whether a study can be done to look for a common exposure or risk factor among thyroid cancer cases in this area of North Carolina.”

SIR stands for Standardized Incident Ratio; CI is short for Confidence Interval. Source: DHHS

 

Thyroid Cancer Letter by Lisa Sorg on Scribd