Presently in North Carolina, our organization is engaged in
On September, 2015, the Medicaid Reform Bill (House Bill 372 or Session Law 2015-245) was signed into law by Governor Pat McCrory.
The law required the Secretary of Department of Health and Human Services (HHS) to apply to Federal HHS for a waiver to alter the state’s Medicaid structure and content.
A draft of the waiver was released March 2016 to the public for comment. An energetic and interactive process included comments from hundreds of affected individuals, representing patients, advocates, providers and institutions. Members of Healthcare for All NC spoke at several of the 12 regional events, emphasizing that the State’s draft plan failed to include expanding the Medicaid program to a wider enrollment criteria (as Medicaid Expansion).
The final version of the state’s waiver application was released in June 2016, with no included Expansion.
The proposal includes a conceptual change for funding service delivery from a state-administered fee-based payment structure to a capitated payment mechanism, offering incentives to providers to control costs within a per-patient monthly fee, limiting the state’s payments. The mechanism creates competing state-designated commercial networks which will then contract for services to actual healthcare providers. Other features include eventual combination of medical and mental health services and support for organized primary care care management.
Viewed from HCfANC’s objective for a Single-Payer non-commercial program, objections to structure of the proposed Reform include:
- capitated care as a structure for restrictions on cost (by restricting care)
- corporate, for-profit management
- competitive networks with overlapping wasteful bureaucracies
consequences of dismantling the Community Care of North Carolina’s well-developed non-profit, award-winning, provider-led regional networks
Most important remains the absence of any new enrollment (Expansion) for North Carolinians left “in the gap”, unable to afford insurance offerings through the Affordable Care Act’s Marketplaces, often too poor even to qualify for any Federal subsidies for these products.
The Federal evaluation of the state’s proposal triggers a negotiation over the content and implementation of the waiver. Federal HHS has the opportunity to
require negotiate expansion of the state’s Medicaid program to include enrollment of non-disabled low-income adults into the new Medicaid. Many see this opportunity as a critical chance to offer healthcare to up to 500,000 of NC’s uninsured. Once an agreement is achieved between the NC & US administrations, the NC Legislature might accept the combination of Reform and Expansion.
The Federal HHS assessment includes collecting new comments from affected parties, and our organization STRONGLY encourages members to endorse including Expansion into the Reform Waiver. Comments must be submitted to the Federal Medicaid website, here, before July 20, 2016.
A well-referenced analysis of the State’s proposal is posted at the NC Justice Center. The detailed whitepaper specifically targets the ways that adding Expansion’s additional enrollees will enhance the impact of the proposed redesign Medicaid.
Current objections to NC Medicaid relate to “cost overruns” and climbing budgets. Truth is, the over-runs have stopped and a surplus was reported in 2014 and 2015. Some argue that previous years’ overruns were due to legislative low-ball budget edits, without considering healthcare inflation.
In fact, North Carolina’s Medicaid inflation is one of the lowest in the country. This success is led by a professional, physician-managed program for clinical excellence and cost control developed under the Community Care of North Carolina (CCNC).
Medicaid Expansion was originally baked-in to the Affordable Care Act (ACA), offering Federal support for states to newly cover healthcare costs for adult poor citizens paid below 138% of the Federal Poverty Limit. Previously, Medicaid is available to poor individuals only if they’re also Disabled, Elderly, Children or Pregnant, leaving out 500,000 able-bodied N.Carolinian adults, even if their income reaches zero.
Sometimes overlooked in the the Roberts’ Court’s June 2012 endorsement of the ACA was its impact on Medicaid. Contradicting obliged universal participation, the Supremes made it optional state-by-state. For several months, the HUGE financial advantages of free (for 3 years and later 90%) Federal subsidization of the offer led many to expect that states would accept the opportunity (and the recommendation of every clinical, or public health organizations’ assessment, including the NC Institute of Medicine).
Instead, in Jan. 2013, NC Senate Bill 4 was passed, then endorsed by the House and Governor McCrory, cancelling enhanced coverage. Despite participation by “white-coat” professional groups, grass-roots efforts at Moral Monday Movement and 80,000 participants at “Historic Thousands on Jones St.”, there’s been no change in plans (or representation) in the Republican-controlled Legislature or Statehouse.
Many expected that the Governor’s position would shift first, after finding opportunity to declare that “broken” financial model of current Medicaid (a 2/3 Federal, 1/3 State cost-share) was “fixed”. This effort at Reform of current Medicaid will almost surely expand providers’ current quality incentives to place them at-risk for some financial costs of care. Discussions about this structure remain fractious, but most believe that Expansion is contingent on a Reform of the prior system.
Current Status of Policy and Politics
In October 2014, Secretary Wos of NC Health and Human Services predicted that efforts to accept Federal support to expand Medicaid would begin “soon”. However, since that time, the Federal election of Thom Tillis from Speaker of the NC House to Senator seemed to signal public acceptance of ACA resistance. Tillis’ replacement, selected by the Republican Caucus in Novermber, is Asheboro Rep. Tim Moore. Even on his very first press contact, to-be-Speaker Moore explicitly opposed any consideration of Expansion.
Grassroots Activism and Policy Options
Two ongoing collaborative groups (with overlapping membership) are working to support Expansion.
A “Policy Group” (led by the brilliant wonks at the Health Access Coalition | NC Justice Center) is monitoring the Administration’s likely effort to follow other Republican governors, seeking a Federal Waiver to modify the traditional governmental Medicaid program. These include private management, varying details regarding participant qualific
Another active “Advocacy Group” is also working to spread awareness of the human consequences, and to seek public support. This group plans outreach through:
– Support for county and city councils’ consideration of resolutions endorsing Expansion
– Preparation of kits for congregations’ endorsements for Expansion
– Establishing a petition website for individuals to sign, endorsing Expansion
– Building an informal online roster of self-reporting individuals (with compelling stories) detailing the human costs of healthcare barriers, in a state-wide web-site named “NC Left Me Out“.
– Staged a week-long campaign to send messages to the Governor
– Joined a special interdisciplinary day of Legislative Action
– Posted our synchronized website calculating the cost of failing to expand
HCfA-NC Board Members have been energetically present in many groups, and welcomes any member’s interest to join these proceedings.
What is Single Payer?
Content from PNHP‘s longer narrative & resources.
Single-payer national health insurance, also known as “Medicare for all,” is a system in which a single public or quasi-public agency organizes health care financing, but the delivery of care remains largely in private hands. Under a single-payer system, all residents of the U.S. would be covered for all medically necessary services, including doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs.
The program would be funded by the savings obtained from replacing today’s inefficient, profit-oriented, multiple insurance payers with a single streamlined, nonprofit, public payer, and by modest new taxes based on ability to pay. Premiums would disappear; 95 percent of all households would save money. Patients would no longer face financial barriers to care such as co-pays and deductibles, and would regain free choice of doctor and hospital. Doctors would regain autonomy over patient care.
What about Obamacare?
The Affordable Care Act (“Obamacare”) aims to expand coverage to about 30 million Americans by requiring people to buy private insurance policies (partially subsidizing those policies by government payments to private insurers) and by expanding Medicaid. However:
• About 30 million people will still be uninsured in 2023, and tens of millions will remain underinsured.
• Insurers will continue to strip down policies, maintain restrictive networks, limit and deny care, and increase patients’ co-pays, deductibles and other out-of-pocket costs.
• The law preserves our fragmented financing system, making it impossible to control costs.
• The law continues the unfair financing of health care, whereby costs are disproportionately borne by middle- and lower-income Americans and those families facing acute or chronic illness.
This handy chart compares single payer and the ACA.
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Over the past two decades, peer-reviewed research by PNHP leaders framed the debate on health care and focused it on the need for fundamental reform. Our proposals detail what a single-payer system in the U.S. could look like.