Medicaid Reform and Expansion Panel Writeup

NC NOW still sees the need to expand Medicaid and is worried about the plans to reform Medicaid.  A few of us attended a panel “Medicaid Reform and Expansion: A Panel Discussion” on April 20th, 2016 at the NCSU McKimmon Conference Center (starting at 7:30pm).  This League of Women Voters (LWV) sponsored event featured a panel discussion about Medicaid reform and expansion in North Carolina. Panelists were Susan Shumaker, President of the Cone Health Foundation; Rob Luisana of Pilot Benefits; and Representative Marilyn Avila, House District 40 (R-Wake).  Dr. Jim Foster was the moderator and MC (he is standing at the podium in this picture).  Dr. Foster is a Retired Cardiologist, and a member of the LWV-ODC.

Photo Credit: LWV-Orange/Durham/Chatham Counties

First Dr. Foster explained the difference between Medicaid and Medicare.

  • Medicare is a federal program which handles people over 65 years old. Medicaid covers low income people, pregnant women, children, and also disabled people.  Medicaid is managed by each individual state.
  • In North Carolina, Medicaid pays for only 30% of people with low or no income. It covers parents with low income if and only if family income is less than 45% of the federal poverty level, which is only $9,040 for a family of 3.
  • Many poor people are not eligible, especially adults without children.  In NC, estimates run from 300,000-500,000 people are not currently eligible for Medicaid.  There is nothing available for them.  
  • The Affordable Care Act (aka Obamacare, written with pride) is only for those who make at least 100% of the federal poverty level (fpl). A person or family that makes less than 100% of the fpl is ‘too poor’ for subsidized health insurance.  100% fpl is $11,770 per year for a single person.  It is $24,250 for a family of 4.  The coverage gap runs from 45% to 100% fpl.

People who fall into the coverage gap have limited health care options.

  • Emergency Rooms at hospitals for care, usually when their problems are very acute.  (Note – hospitalization costs are passed on to taxpayers in the form of higher taxes and health insurance premiums).
  • Community Health Centers
  • Charity Care (like at UNC)

Mostly those in the coverage gap don’t get much care at all.

Rep. Marilyn Avila was the first panelist to speak and she spoke a bit long about her upbringing, her background, and how she is working on committees in areas in which she doesn’t have the background – Health and Human Services, troubled kids.  She has owned businesses, was trained as a Chemist, and used to work for the Locke Foundation (very conservative organization).  She did mention that 30 counties do not have a single OB-GYN, and 5 in a row do not have a single psychiatrist or psychologist.  Her thought was there are no doctors so don’t cover them (not thinking that the money may bring in doctors and other health professionals).  Avila quoted a 2008 study in Oregon that said Medicaid can hurt your health.  This study was politely refuted by Dr. Foster who had written a long rebuttal on how the cases in the study were cherry-picked, not random. My data friend was appalled that Avila quoted such an outdated study.

The second panel speaker was Susan Shumaker, who has decades of professional experience in health care.  Shumaker is president of Cone Health Foundation, a Greensboro based organization that works to measurably improve the health of people in the greater Greensboro area.  It focuses on the areas of access to health care, adolescent pregnancy prevention, HIV, and substance abuse & mental health.  Shumaker has a master’s degree in health administration and a bachelor of science degree in nursing from Duke University, as well as more than 25 years experience in healthcare leadership.

Shumaker also volunteers under-served populations in free clinics and treats Medicaid patients herself.  She told stories of patients.  Then cited facts and studies.

In regular Medicaid (outside of the Medicaid Expansion deal with the federal government), the federal government covers 66% of the costs, states cover 34%.  With Medicaid Expansion, the feds were covering 100% of the cost, tapering to 90% by 2020 – still an excellent deal.

Who would benefit from closing the coverage gap?

  • 66% are working poor – in occupations on which we rely, like construction, food service, sales, and childcare.  Some of these people are working 2 or more jobs to get by.  
  • Some are caregivers, like stay at home parents or children taking  care of elderly relatives.

Shumaker quoted a study of NC’s Medicaid/Health Care situation in all 100 counties in NC.  The study was authored by researchers at Milken Institute School of Public Health at the George Washington University, and funded by Cone Health Foundation (her organization) and the Kate B. Reynolds Charitable Trust.  This study concluded that expanding Medicaid in NC would lead to nearly $22 billion in increased business!! The study was published in December 2014, and shows the effects of expanding Medicaid county by county. She also showed how Medicaid expansion costs would even out or put NC in better shape with the many benefits to the state of expanding Medicaid (jobs, money, more services needed and covered, etc).

Ms. Shumaker is quoted in the release article.  “We have some of the most restrictive Medicaid eligibility requirements in the country, so hundreds of thousands of low-income North Carolinians will benefit if the program expands. The decision not to expand the program impacts all of us, not just those who are struggling to access the care they need to stay healthy. It has already also cost jobs and billions of dollars, and will continue to do so.”

Rob Luisana from Guildford County was the third panelist to speak.  He said he often speaks on Medicaid reform, and its impact on business employers.  He posed a question, “Should every American have access to health care?”  And talked about what the answer says about us, considering America is the richest nation, and the only (rich) one not covering all of its citizens.  He lamented politics interfering with health care.  As an insurance agent, he also deals with real people and the coverage gap.  He talked about specific cases and how some specific people are covered and some are not.  He also reiterated how unpaid hospital stays billed at higher rates cause higher premiums for others.

Dr. Jim left lots of time for questions, and we could have continued much longer with those.  Questions about what will happen with United Health Care possibly pulling out of ACA coverage, Medicaid reform, and peoples’ personal experiences and problems with American health care were brought up.  For Medicaid reform, the McCrory administration is concerned about increasing Medicaid costs and wants to force those costs on doctors.  The obvious question is why would doctors go for that?  

All in all, it was a great forum.  3 of 4 of the speakers were on board with the need for and advantages from Medicaid Expansion. We can only hope that Rep. Avila reads the Milken study and learns from the experience shared on the panel.

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