Polls about the Affordable Care Act (ObamaCare) nearly always show that the law is unpopular. Despite having positive opinions about the law’s separate components, including improved coverage for kids, seniors’ meds, and pre-existing conditions, most Americans continue to cringe. Obamacare’s polling has virtually never crossed above the 50 percent approval mark.
So, the North Carolina legislature’s bold stand against any cooperation with the law, including rejecting an expansion in Medicaid coverage (with associated federal funds), might have been popular. Not so.
ProgressNC gathered details from Hamilton Campaigns (a national professional polling contractor) regarding NC voters’ ideas on Medicaid’s Expansion.
— Two-thirds support accepting federal funds to expand access to health care.
— More than three-quarters say they are more likely to support a candidate for office that votes to accept federal funds for Medicaid expansion.
— Only 18% say Gov. Pat McCrory should continue his opposition to Medicaid expansion.
In particular, polls reject the decision not to expand Medicaid coverage to 500,000 additional adults with very low incomes.
Despite this, 2014 will see no legislative reversal. So, for 2014, we have lost the opportunity to extend health insurance to nearly everyone. So what’s next for the state’s poor and uninsured? The answer is complex and uncomfortable.
Federally managed “Health Insurance Marketplaces” will be open Oct. 1, 2013 – March 31, 2014, for small businesses and individuals, regardless of income or health condition. Marketplaces are designed for those under 65 who do not have Medicaid or other comprehensive employer coverage. Because Medicaid expansion was assumed, ObamaCare’s price-supports offer no subsidies for the very poorest (below 100 percent of the federal poverty level).
Even where subsidies are available, plans offered to very low-income North Carolinians may be unaffordable (defined as monthly premiums are more than 8 percent of incomes), canceling the $95 annual penalty for the uninsured..
So where can the uninsured go for care? Sadly, the answers are unchanged, and resources are even more limited.
Lincoln Community Health Center delivers the lion’s share of care to Durham’s low-income residents. Though only 18 percent of its patients are covered by any insurance (including Medicaid and Medicare), it somehow manages to provide visits, medications and improved health outcomes to thousands of our neighbors. Direct federal support to Lincoln and similar federally qualified healthcare facilities will dramatically decline beginning in 2016 (as expanded Medicaid was intended to support these centers).
Hospital Emergency Departments are sometimes the only choice open to the poor. Unfortunately, support for hospitals that covers the uninsured is also slated to fade. Many expect some hospitals to fail, especially those in rural areas and those that target their community’s underserved, where expanded Medicaid was expected to create new opportunities.
Charity care remains another vigorous (if threadbare) opportunity. Volunteer and donation-supported care is provided locally at modest facilities by CAARE Inc and Samaritan Clinics and by Project Access of Durham County. Sadly, similar programs statewide expect falling support, especially from local hospitals and national pharmaceutical manufacturers. Hopefully, private and public support will continue, but are unlikely to fill the widening gaps and climbing need. Energetic volunteers with time and clinical credentials are always welcome.
How North Carolina’s current Medicaid may change
Governor McCrory and HHS Secretary Wos are working to reconstruct the state’s award-winning Medicaid program, Community Care of North Carolina.. The Raleigh administration is seeking a federal waiver to privatize how Medicaid is delivered in North Carolina. They believe that enhanced competition may significantly reduce costs and that mental health services can be better integrated into medical care.
Many hope that when these program changes are in place for the current Medicaid program, they might lift their objection to expanding Medicaid.
We are surrounded by neighbors without access to necessary healthcare, especially for basic and preventive services. A legislative reversal to expand Medicaid, would be welcomed in the Tarheel state.
Gary N. Greenberg, MD, MPH, wrote this on behalf of Durham CAN, Project Access Durham County, Partnership for a Healthy Durham