Medicare Slow To Adopt Telemedicine Due To Cost Concerns
By Phil Galewitz
Donna Miles didn’t feel like getting dressed and driving to her physician’s office or to a retailer’s health clinic near her Cincinnati home.
For several days, she had thought she had thrush, a mouth infection that made her tongue sore and discolored with raised white spots. When Miles, 68, awoke on a wintry February morning and the pain had not subsided, she decided to see a doctor.
So she turned on her computer and logged on to www.livehealth.com, a service offered by her Medicare Advantage plan, Anthem BlueCross BlueShield of Ohio. She spoke to a physician, who used her computer’s camera to peer into her mouth and then sent a prescription to her pharmacy.
“This was so easy,” Miles said.
For Medicare patients, it’s also incredibly rare.
Nearly 20 years after such videoconferencing technology has been available for health services, fewer than 1 percent of Medicare beneficiaries use it. Anthem and a University of Pittsburgh Medical Center health plan in western Pennsylvania are the only two Medicare Advantage insurers offering the virtual visits, and the traditional Medicare program has tightly limited telemedicine payments to certain rural areas.
And even there, the beneficiary must already be at a clinic, a rule that often defeats the goal of making care more convenient.
Congress has maintained such restrictions out of concern that the service might increase Medicare expenses. The Congressional Budget Office and other analysts have said giving seniors access to doctors online will encourage them to use more services, not replace costly visits to emergency rooms and urgent care centers.
In 2012, the latest year for which data are available, Medicare paid about $5 million for telemedicine services – barely a blip compared with the program’s total spending of $466 billion, according to a study in the journal Telemedicine.
“The very advantage of telehealth, its ability to make care convenient, is also potentially its Achilles’ heel,” Ateev Mehrotra, a Rand Corp. analyst, told a House Energy and Commerce subcommittee last year. “Telehealth may be ‘too convenient.’”
But the telemedicine industry says letting more beneficiaries get care online would reduce doctor visits and emergency care. Industry officials as well as the American Medical Association, the American Hospital Association and other health experts say it’s time for Congress to expand use of telemedicine in Medicare.
Popular outside Medicare
“There is no question that telemedicine is going to be an increasingly important portal for doctors and other providers to stay connected with patients,” former Surgeon General Richard Carmona said in an interview.
Some health experts say it’s disappointing that most seniors can’t take advantage of the benefit that many of their children have.
“Medicare beneficiaries are paying a huge price” for not having this benefit, said Jay Wolfson, a professor of public health, medicine and pharmacy at the University of South Florida in Tampa. For example, he said, telemedicine could help seniors with follow-up appointments that might be missed because of transportation problems.
Aetna and UnitedHealthcare cover telemedicine services for members younger than 65, regardless of whether enrollees live in the city or in the country. About 37 percent of large employers said that they expect to offer their employees a telemedicine benefit this year, according to a survey last year by Towers Watson, an employee benefits firm. About 800,000 online medical consultations will be done in 2015, according to the American Telemedicine Association, a trade group.
Medicare’s tight lid on telemedicine is showing signs of changing. In addition to Medicare Advantage plans, several Medicare accountable care organizations, or ACOs – groups of doctors and hospitals that coordinate patient care for at least 5,000 enrollees – have begun using the service.
Medicare Advantage plans have the option to offer telemedicine without the tight restrictions in the traditional Medicare program because they are paid a fixed amount by the federal government to care for seniors. As a result, Medicare is not directly paying for the telemedicine services; instead, the services are paid for through plan revenue.
Republicans and Democrats in Congress are also considering broadening the use of telemedicine; some of them tried unsuccessfully to add such provisions to the recent law that revamped Medicare doctor payment rules and to the House bill that seeks to streamline drug approvals.
‘Changing this dynamic’
This year, Medicare expanded telemedicine coverage for mental health services and annual wellness visits when done in certain rural areas and when the patient is at a doctor’s office or health clinic.
“Medicare .. is still laboring under a number of limitations that disincentivize telemedicine use,” said Jonathan Neufeld, clinical director of the Upper Midwest Telehealth Resource Center, an Indiana-based consortium of organizations involved in telemedicine. “But ACOs and other alternative payment methods have the possibility of changing this dynamic.”
AARP wants Congress to allow all Medicare beneficiaries to have coverage for telemedicine services, said Andrew Scholnick, a senior legislative representative for the lobbying group. “We would like to see a broader use of this service,” he said. He stressed that AARP prefers that Medicare patients use telemedicine in conjunction with seeing their regular doctor.
The American Medical Association has endorsed congressional efforts to change Medicare’s policy on telemedicine, as has the American Academy of Family Physicians. “We see the potential for it … to improve quality and lower costs,” said Robert Wergin, president of the academy and a family doctor in Milford, Neb. He said such technology can help patients who are disabled or don’t have easy transportation to the doctor’s office.
Anthem, which provides its telemedicine option to about 350,000 Medicare Advantage members in 12 states, expects the system to improve care and make it more affordable.
“It’s also about the consumer experience and giving consumers convenience to be able to be face to face with a doctor in less than 10 minutes, 365 days a year,” said John Jesser, an Anthem vice president. Anthem provides the service at no extra charge to its Medicare Advantage members.
While seniors are more likely to have more complicated health issues, telemedicine for them is no riskier than for younger patients, said Mia Finkelston, a family physician in Leonardtown, Md., who works with American Well, a firm that provides the technology behind Livehealth.com. That’s because the online doctors know when they can handle health issues and when to advise people to seek an in-person visit or head to the emergency room, she said.
“Our intent is not to replace their primary care physician, but to augment their care,” she said.
Advocates Urge Measures to Prevent Drunk Driving
MADD leadership and volunteers gathered at the legislature to push for a law requiring ignition interlock devices for all convicted drunk drivers.
By Rachel Herzog
If new legislation is successful, advocates for tighter restrictions on drunk driving won’t have to hold their breath for much longer.
In 2007, North Carolina passed a law requiring repeat drunk driving offenders or first-time offenders with a blood alcohol concentration of 0.15 or greater to have ignition interlock devices installed in their cars. Those devices require drivers to pass a breath test before starting their cars.
Now 25 other states have laws that require first-time offenders with a BAC of 0.08 or greater to install the devices. The advocacy group Mothers Against Drunk Driving is pushing to make North Carolina the 26th by calling for the passage of two bills that would do the same thing.
“We’re looking to do this with all offenders first time out of the gate so we can help reduce the amount of people dying here,” MADD’s national president, Colleen Sheehey-Church, said in a press conference at the General Assembly Tuesday.
Not the first time
Why impose the device on first-time offenders?
“A majority of people who kill or injure others in drunk-driving crashes do not have prior conviction,” said Frank Harris, MADD’s director of state government affairs.
According to the Centers for Disease Control and Prevention, convicted drunk drivers have typically driven while impaired at least 80 times a year before being apprehended for the first time.
Get notifications of new NC Health News stories to your newsfeed – “like” us on Facebook today! “When you consider that for a first-time offense, it’s really not their first time,” MADD volunteer Luke Marcum, a police officer, said. “We want to eliminate the likelihood that they’re going to turn around and do this again.”
This is the second year MADD has tried to get this bill passed in North Carolina, Marcum said, adding that it already has a lot of support from the law enforcement community.
How it works
According to a study by the private nonprofit Transportation Research Board, 50 to 75 percent of convicted drunk drivers continue to drive with a suspended license.
“The ignition interlock is not necessarily a harsher sanction,” Harris said. “It’s a more effective sanction.”
An ignition interlock allows people to drive but eliminates the possibility they drive drunk while the device is installed.
“We totally understand that an ignition interlock may not be a silver bullet, but it is the best technology that we have today,” Sheehey-Church said. “It’s something that can help teach someone how to drive sober.”
The device contains a breathalyzer, which the driver must use to prove their sobriety before starting the car. It also requires a running retest, which the driver must blow at random intervals, typically about five minutes after the car is started and about 40 minutes to an hour later.
The process takes about 20 seconds, and the device gives the driver a few minutes to pull over for retests.
Worth the cost
According to the CDC, interlocks are effective in saving lives and reduce drunk driving repeat offenses by 67 percent.
The devices cost $2.50 per day to lease from an interlock vendor, or more than $900 for the year their license would be suspended. The convicted drunk driver pays for their own device, and if they can’t afford it funds from other interlock users cover the cost.
“If you’re arrested for a DUI in North Carolina today, you should probably go see your banker and get you a personal note for about $10,000,” DMV and law enforcement consultant Mike Robertson said. “You’re going to pay an attorney, you’re going to pay insurance, you’re going to pay for an interlock device.”
But while people generally aren’t thrilled about the expense and inconvenience, they may find interlocks helpful in the long run. Bryce Little, market coordinator for the North Carolina-based interlock provider Monitech, said for some people they serve as a safety net from letting alcohol control their lives.
“People need to get to work, they need to go and do things,” he said. “So what they’ll do is they’ll get an interlock if they get a DUI, and they’ll have to use it.”
“It can really help them get back on the road, help them get back in a place where they would like to be,” Little said.
House Bill 877 was referred to a judiciary committee on April 15, and Senate Bill 619 was referred to another judiciary committee on May 7.
“I think the caucus supports it, and I think that there will be some work to do to get some minor roadblocks dealt with,” said Rep. Jonathan Jordan (R-Jefferson), one of the bill’s primary sponsors. “I think we can do that.”
Federal Grant Will Help Thousands Recover from Substance Abuse
By Rose Hoban
More than 4,000 people who are working to recovery from substance abuse disorders will have some extra help, thanks to a $7.8 million federal grant that’s coming to North Carolina.
The Department of Health and Human Services announced late Monday that the grant, from the federal Substance Abuse and Mental Health Services Administration, will be targeted at helping people get sober and back on their feet.
According to a press release from DHHS, the grant will focus on homeless people, people getting out of jail or prison for drug-related convictions and pregnant and parenting women, among others.
Did you know NC Health News is a non-profit? Last year, a third of our funding came from readers. Please consider a donation today! “There are some dollars for things like medical, dental, vision,” said Terri Conyers, a service director at Recovery Communities of North Carolina, the agency that will be managing the three-year grant.
“Imagine you haven’t been to a dentist in five years, but you can get cleaning, X-rays, exams,” she said. “That’s huge for someone. It gives people some hope.”
The grant will go to support recovery services, a different approach to providing substance abuse services than in the past. As Conyers explained it, recovery services take into account the fact that there’s no one way to get one’s life together after using substances for years.
“Every journey doesn’t have to look like my journey,” said Conyers, who talked about being drug and alcohol free since 2007.
“In the past, there were a only a couple of approved ways to get sober, and unless you took one of those routes you weren’t [considered] successful. But there’s a growing recognition that there are multiple ways to recovery,” she said.
And that’s the point of the funding, said Courtney Cantrell, who leads the state Division of Mental Health, Developmental Disabilities and Substance Abuse Services.
“This grant provides us with a great opportunity to extend the state’s services and enable people with substance use disorders to independently choose the services that will best support their recovery,” said Cantrell in a press release from DHHS.
No longer anonymous
in the past, one of the main pathways to sobriety was through mutual aid networks such as Alcoholics Anonymous or Narcotics Anonymous, but Conyers said a big shortcoming is that people involved in those movements remained anonymous. As a result, addicts and alcoholics didn’t talk publicly about their struggles or their successes, and the stigma against people with substance abuse problems never really abated.
“You see that guy at the corner with a sign, and you think, ‘He’s a bum, a drunk,’” Conyers said. “But a lot of those people recover. And then they fall off the radar once they get better. What happens when that individual gets sober? They become productive members of society.”
Recently, there’s been a movement to get more people to talk publicly about how they recovered from substance abuse and to encourage others to get their lives back together.
Conyers described how people who are starting to get drug free often just need a little help getting started. The SAMHSA grant money might go to paying someone’s first month’s rent before they get a paycheck, for instance.
“Say you’re a month behind in rent and you’re stressed out. It’s overwhelming,” she said. “So they would come into our office or the office of one of our partners [and] get an assessment.
“At that point, we sit down and make a plan for their recovery, what are thee goals you’d like to attain, what are your largest barriers at this moment,” then issue a rent voucher to help tide the person over. Conyers said her organization would then follow the person’s progress, providing encouragement, assistance and guidance.
“There’s some money for education, money for child-development classes, some parenting classes for when they’re getting sober and there’s children in their lives,” she said.
Recovery Networks of North Carolina is a relatively new organization, with offices in Wake, Durham, Johnston and Robeson counties, with other offices planned for Western North Carolina in the coming year. Conyers also said that with the grant money, the organization plans opening several “recovery community centers” in four locations around the state.
“You get sober and then you’re like, ‘What do I do with this time?’” she said. “These recovery centers will allow people to have sober life experiences and have fun with people who understand and are like-minded and share their experiences.”
Press Release: Shark Victim Update
UNC Children’s chief surgeon, Dr. Bill Adamson, shares details about the care and treatment of 12-year-old Kiersten Yow, who was transferred to UNC Hospitals following a June 14 shark attack on Oak Island, N.C. As of 4 p.m., June 25, Yow remains in good condition. Here is her update:
Kiersten Yow was transferred to UNC Children’s Hospital from New Hanover Regional Medical Center on Monday, June 15, 2015, due to injuries she sustained during a shark attack the previous day. With her parents’ permission, I am releasing details regarding her subsequent care.
Kiersten had two surgeries during her first week at UNC—one on Tuesday, June 16, and another on Friday, June 19. In both cases, surgeons performed “operative debridement,” removing dead and damaged tissue from the wounds on her left arm and left leg, and changed the wound dressings.
Yesterday afternoon, June 24, Kiersten had her first reconstructive surgery. A team of surgical specialists covered the leg wound with a skin graft and completed initial reconstruction of the elbow, reattaching the tendons to provide maximal range of motion. Reconstruction of the elbow will continue in the coming weeks with surgical wound care and skin grafting on her arm.
Kiersten was walking with assistance before yesterday’s surgery and will be doing so again soon, although she is currently confined to her hospital bed for the skin grafting to heal. The bite wound on her leg, situated around the rear upper thigh, fortunately did not reach bone or the nerves that control the lower leg, so despite some muscle loss, we expect the skin grafting alone will provide her good function. With rehabilitative therapy, we anticipate she will remaster walking independently and even be able to exercise.
Kiersten continues to amaze her entire care team with her upbeat, can-do attitude, which is truly extraordinary for a girl her age given the trauma she experienced. There’s been no, “Why me?” or sulking, just a dogged determination to reestablish her independence and return to a normal life—and we are proud to play our part in getting her and her family there.
Governor Signs Bill Limiting Environmental Reviews
By Gabe Rivin
Under a new law, state agencies must limit their reviews of projects that can impact the environment and the public’s health.
The new law, signed last Friday by Gov. Pat McCrory, reforms the State Environmental Policy Act, or SEPA, a decades-old law that critics say has grown unnecessary and burdensome, but which supporters say provides an important tool to protect the environment.
SEPA requires state agencies to review the environmental effects of some state-funded projects. Until now, SEPA didn’t force agencies to consider the costs of a project in determining whether to do a review.
But under the reform law, HB 795, projects may only be reviewed if they cost more than $10 million or affect more than 10 acres of public land.
HB 795 is significant in part because SEPA takes into account the public’s health. The law considers a project’s effects on groundwater, air pollution and the creation of hazardous wastewater, among other issues.
The votes for HB 795 were largely split on partisan lines, with Republicans offering the bulk of support for the bill. Still, the bill’s dissenters included two notable Republicans from the House Environment Committee: Rep. Rick Catlin (R-Wilmington), a chairman of the committee, and Rep. Chuck McGrady (R-Hendersonville), a vice chairman.
“They’re calling it reform,” said McGrady, referring to the bill’s supporters. “For all practical purposes, it’s a repeal.”
McGrady said that under the new law, the monetary thresholds will prevent most projects from triggering a SEPA review.
At the N.C. Department of Environment and Natural Resources, that would have been the case for recent projects, according to Tom Reeder, the department’s assistant secretary for the environment. Reeder couldn’t say with certainty how many previous projects would have been affected by the new law; the department doesn’t track projects’ cost.
But of the 14 projects reviewed last year under SEPA, “Probably most of them would be kicked out” from SEPA review, he said.
How SEPA works
SEPA was signed into law in 1971 in an effort to protect the environment and the public’s health and to ensure that taxpayer-funded projects would receive public scrutiny for their environmental effects.
Where else could you read this story? NC Health News fills a valuable need, reporting on stories the other guys skip. Please consider a donation to support this vital service!SEPA reviews apply to activities that meet three criteria.
An activity must involve a state agency’s action. This can include an agency’s decision to issue a pollution permit or to build a sewer-line extension, for example.
The activity must also use public money, from state or local governments, or state lands.
And the activity must potentially impact the environment or the public’s health to a significant degree.
Having met those criteria, agencies perform a SEPA review. In the reviews, agencies look at several issues, including a project’s environmental effects, measures to lesson those effects and possible alternatives to the project.
SEPA’s supporters and opponents
SEPA’s supporters say the process helps applicants prepare for future environmental permits and that SEPA reviews consider broader potential effects than those considered under some regulatory programs, such as air pollution permitting programs.
The N.C. Chamber, which championed HB 795 in the General Assembly, said that SEPA has been burdensome for businesses.
“This drawn-out and often unnecessary process can add years to the development of new economic opportunities and impede job growth,” said Gary Salamido, N.C. Chamber’s vice president of governmental affairs, in a press release.
Kenneth Waldroup, an assistant director for public utilities in Raleigh, said that while he doesn’t advocate a repeal of SEPA, the public should consider the large number of environmental requirements already placed on public projects. The combination of state and federal laws, he said, “has made permitting projects extremely complicated.”
HB 795 does not repeal any state programs that regulate pollution, such as air pollution or water pollution. These regulations are required under different state laws.
Reeder, of DENR, said he expects the new law to have negligible effects on the environment.
“These projects will still undergo a comprehensive environmental review,” he said.
Yadkin County Hospital Operator Found in Contempt of Court
By Taylor Sisk
A federal judge for the Eastern District of North Carolina ruled on Tuesday that HMC/CAH Consolidated Inc., which formerly operated the Yadkin Valley Community Hospital, was in contempt for closing the 22-bed hospital when a temporary restraining order to keep it open was in effect.
The judge ordered HMC/CAH to pay damages to Yadkin County for expenses the county has incurred that include the cost of additional emergency services from the day the hospital closed until it reopens. The county must submit to Judge Terrance Boyle a plan to reopen the hospital and an assessment of the damages.
Judge Boyle’s ruling also stipulated that HMC/CAH will be given an opportunity to purge its contempt order by providing opportunities for patients to receive their medical records and by returning county property.
HMC/CAH, a Missouri-based private equity firm, acquires and manages rural critical access hospitals with the goal of “replacing those older hospitals with new, state-of-the art facilities,” according to the company’s website.
The company filed for Chapter 11 bankruptcy in 2011 after losing money for several years and then having a financing deal fall through. The company never managed to build a new facility at the Yadkin Valley Community Hospital site. HMC/CAH also owns Washington County Hospital in Plymouth.
Yadkin County Attorney Edward Powell said that around lunchtime on May 22, county officials learned that hospital administrators planned to cease operations the following morning.
Later that afternoon, the county filed a temporary restraining order in superior court in Raleigh to keep the hospital open. Records indicate that the restraining order was emailed at 5:59 p.m. to Dennis Davis, chief legal officer for Rural Community Hospitals of America, which manages the hospital for HMC/CAH.
At 6:04, Davis responded, “The hospital is already closed.”
According to affidavits filed by employees of the hospital, administrators told staff at around 6 p.m. to complete treatment of the remaining patients in the emergency department and discharge them, and began shutting down the hospital. The patients were discharged at about 6:40. There were no inpatients.
But in a document filed with the court on June 15, HMC/CAH officials countered that they did not receive notice of the temporary restraining order until after the hospital had closed.
They further alleged that at approximately 5 p.m., the hospital was “surrounded by Yadkin Valley County Sheriff’s officers,” and administrators were informed that the hospital staff was being evicted.”
Powell termed this a “totally inaccurate portrayal” of events. He said no civil process of eviction was filed and that Sheriff Ricky Oliver had sent the deputies out to try to ensure that no property was removed from the premises.
HMC/CAH officials acknowledged that they had intended to close the hospital the following morning.
As things stand
HMC/CAH’s lease agreement with the county had been due to expire at the end of April, but was later extended to the end of July. Negotiations between the two sides had not gone well, and the county issued a request for proposals for operation of the hospital.
HMC/CAH officials wrote to the county in May expressing concerns that the process was taking too long, creating a state of uncertainty that was “more and more destructive to the hospital.”
The officials wrote at the time that the hospital had lost the services of key personnel. According to the June 15 document submitted to the court, they informed the county that “if clinical and patient support operations deteriorate further, there is a reasonable likelihood that the hospital will not be able to remain open for business until July 31st.”
The county has been in negotiations with Hugh Chatham Memorial Hospital in nearby Elkin to purchase HMC/CAH’s operations licenses and sign a long-term lease.
Powell said on Friday that the county would now “continue negotiations in earnest with Hugh Chatham concerning a new lease of the facility.”
Driver’s Ed Funds Eliminated in Senate Budget
By Rachel Herzog
Updated June 21, 2015
North Carolina teens could end up hitting the road with less driving knowledge under their seat belts, due to an amendment in the Senate budget.
On Tuesday, Sen. Ralph Hise (R-Spruce Pine) proposed a repeal to the requirement that North Carolina teens attend a driver’s education program that has been approved by the State Department of Public Instruction. An appropriations committee voted to add it into the Senate’s proposed budget.
Arthur Goodwin, a senior research associate at the UNC Highway Safety Research Center, said he finds the proposal disappointing.
“By itself, [driver’s education] isn’t sufficient to help teach teens, but it is a very important first step,” he said. “It helps teens learn rules of the road and gives them some introduction with the guidance of a driving professional, and then the teens get turned over to parents to make sure they have lots of experience under their belts.”
Until 2011, high school students could enroll in driver’s education free of charge. That year, the General Assembly cut $5 million from the state’s $32 million fund for driver’s education programs. To compensate, legislators gave school districts the option of charging students a $45 fee to enroll, which school officials say led to a drop in enrollment.
In 2013, lawmakers raised the fee to $55. In 2014, the fee became $65, and the state decided that the program would no longer be funded by the Highway Fund, but by money available to local boards of education.
Now, without any funding from the state, students will have to pay $300 to $400 should they choose to enroll in a driver’s education class.
Organizations such as Raleigh’s Jordan Driving School are urging people to call legislators to protest this loss of funding.
The amendment requires teens to complete 85 hours of supervised driving practice, up from the current requirement of 60. However, Goodwin said there is no research showing that 15 more hours makes a difference.
Like what you read on NC Health News? Get notifications of new stories to your Facebook newsfeed – “like” us today!No other state has repealed driver’s education, but some have proposed systems where parents can let their children opt out of the class.
Texas, for instance, implemented a program in 1997 known as parent-taught driver’s education. According to a report compiled by the National Highway Traffic Safety Administration in 2007, crash rates were proportionally higher among parent-taught drivers than they were among drivers who completed commercial or public school driver’s education programs.
However, Goodwin noted that these studies were not controlled and that there could be other factors in play, such as common characteristics between families who opted out.
On the other hand, Russ Rader, senior vice president of communications for the Insurance Institute for Highway Safety, said driver’s education isn’t as effective as commonly thought.
“Driver education can be very useful in teaching teenagers basic driving skills,” he said. “However, it hasn’t been shown to make teens safer drivers. Teens who go through driver ed aren’t less likely to crash than teens who haven’t taken it. There’s been a lot of research on driver ed over the years, and studies have not shown a safety benefit.”
Rader said that rather than debating driver’s education, North Carolina could focus on improving its graduated licensing program. Small changes such as raising the learner’s permit or licensing ages by six months would each lead to 7 percent reductions in fatal crashes, he said.
If the Senate budget becomes law, new drivers in North Carolina would still have to pass an exam with written and on-road components. The state’s graduated licensing system, which requires 16-year-olds to spend several months with a provisional license and imposes restrictions such as not being able to drive at night or with multiple passengers, will remain in place as well.
The Senate budget gained preliminary approval Wednesday afternoon and a final vote is expected Thursday. The budget then goes back to the House for concurrence, but the two chambers’ budgets are far apart, and Capitol watchers expect it could be weeks before any final budget reaches Gov. Pat McCrory’s desk.
Who Stands to Lose Insurance Premiums in the King v. Burwell Case?
By Rose Hoban
Sometime later this month, the Supreme Court will be ruling on a case that few people have noticed but that could affect millions.
What’s at stake in the case is the provision in the Affordable Care Act that allows people purchasing insurance on the online exchanges to receive tax subsidies to help pay for their insurance premiums.
The case is King v. Burwell.
On one side are lawyers from the conservative Competitive Enterprise Institute representing plaintiffs who say the phrase “established by a state” means that only tax credits that are given out on exchanges created by individual states are allowed.
On the other is Sylvia Matthews Burwell, the secretary of health and human services for Barack Obama since June 2014.
The plaintiffs (the King side) argue that in states such as North Carolina, which uses the federal insurance exchange, those subsidies are invalid.
A ruling in favor of the plaintiffs could eliminate subsidies in North Carolina and 33 other states. Last year, more than 562,000 North Carolinians bought coverage on the federal exchange; 92 percent of those people were eligible for some level of subsidy to help pay their premiums.
Nationwide, more than 4 million people in states that did not establish their own insurance exchanges are at risk of losing their subsidies if the Supreme Court rules in favor of the plaintiffs.
The left-leaning Families USA has prepared this infographic showing where North Carolinians who risk losing their insurance subsidies live and who represents them in Congress.
N.C. Mayor Arrives in D.C. on Quest to Support Rural Hospitals
By Rose Hoban
For the second year running, Belhaven Mayor Adam O’Neal has walked to Washington, D.C. Last year, O’Neal made the journey to raise the red flag over the closure of the hospital in his small eastern North Carolina town.
This year, he walked to raise awareness of rural hospitals facing closure across the country. He arrived at the Capitol on Monday morning.
“The purpose of this walk is that we want awareness that 283 hospitals are facing closure,” O’Neal said by telephone over the weekend as he neared D.C.
“A million dollars per hospital would make all the difference,” he said. “This is not a problem our country can’t fix; it’s a problem that no one is paying attention to.”
According to the National Rural Health Association, 53 rural hospitals across the U.S. have closed their doors since 2011; most of those are in the South.
Experts note several trends at play in Southern hospitals; in particular: Most states in the South declined to expand Medicaid as allowed for under the Affordable Care Act, and small, struggling hospitals lost the revenue they would have gotten from newly covered patients – revenue they were depending on.
“A lot of the closures are in Georgia and Texas, and Georgia’s hospitals have been struggling for years. They tend to have hospitals with smaller volumes,” said UNC-Chapel Hill health economist Mark Holmes in a recent interview with N.C. Health News. “I don’t think it’s clear whether the decision not to expand Medicaid pushed them into closure or whether it was a long-term trend and they just eventually fell over.”
O’Neal also pointed to federal sequestration, which cut payments to hospitals, as well as federal regulations.
And rural hospitals used to receive extra federal funding to care for people without insurance, funding that was phased out under the Affordable Care Act. The assumption in the law was that those patients would have had Medicaid.
Any fixes in sight?
O’Neal said he’s been joined on his walk by activists from Washington, Ohio, West Virginia, Tennessee, Texas, Pennsylvania and Illinois, along with others from North Carolina, which he found heartening.
“We are also hearing that some on Capitol Hill are introducing legislation in the coming weeks to address rural hospitals,” he said. “When a rural hospital closes, Republicans die, liberals die. This should be one issue for Democrats and Republicans to work together to fix.”
“We’re calling on Congress to pass comprehensive legislation to save rural hospitals and patients and to provide a pathway to the future for rural health,” said Alan Morgan, the National Rural Health Association’s CEO, in a press release.
O’Neal, a Republican, gained notoriety last year when he spoke out on Medicaid expansion in North Carolina, aligning himself with Democrats who have called on state lawmakers to expand the program. But for this walk, he said, he had the bigger picture in sight.
“The walk is not about Belhaven, it’s about hospitals closing in a lot of places,” O’Neal said. “Our country has somehow allowed this tragedy to come to our doorstep.
“It’s not finger-pointing. It’s just a nonviolent effort to get the government to pay attention.”
O’Neal ducked the question when asked if he’d put pressure on state lawmakers, where much of the legislation and regulation on hospitals in a state takes place.
“There are other people in North Carolina who can take up causes and do marches,” he said. “As far as I’m concerned, what people need to know is that 283 hospitals are at risk of closing.”
More Patients, Not Fewer, Turn to Health Clinics After Obamacare
Community health clinics are supposed to be the safety net for people without insurance. As the Affordable Care Act gets implemented, even more are showing up at clinic doors.
By Michael Tomsic
WFAE, Kaiser Health News
Nurse practitioner Martha Brinsko helps a lot of patients manage their diabetes at the Charlotte Community Health Clinic.
“Most mornings when you check your sugar, what would you say kind of the average is?” Brinsko asked patient Diana Coble.
Coble hesitated before explaining she ran out of the supplies she needs to check her blood sugar levels and she didn’t have the gas money to get back to the clinic sooner. Brinsko helped Coble stock up again.
Coble – who is unemployed, lives with her sister and can’t afford insurance even now that the health law is in place – relies on the clinic for health care.
“They do a great job with everything,” Coble said. “I couldn’t do without them.”
Nancy Hudson was the clinic’s director as Obamacare rolled out and now consults for the clinic. She expected the insurance exchange, or marketplace, established under the Affordable Care Act would reduce the number of uninsured patients the clinic sees.
The opposite happened, she said.
“What we found within our patient population and within the community is that a lot of the advertisement and information about the marketplace brought people [in who] didn’t know anything about free clinics and did not qualify for any of the programs within the ACA marketplace,” Hudson said.
And now they get free or low-cost care at the clinic, which is designated by the government as an FQHC, or federally qualified health center.
The health law was designed to cover the poorest people by expanding Medicaid, the federal-state program for low-income people. But the Supreme Court made that optional. The result in states that didn’t expand Medicaid is a gap, where some people make too much money to qualify for Medicaid but not enough to qualify for insurance subsidies.
In North Carolina, about 319,000 people, like Coble, fall into the Medicaid gap.
“Over half of the people that we see would’ve been eligible for Medicaid expansion had the state elected to exercise that option,” said Ben Money, president of the association that represents North Carolina’s community health centers.
North Carolina is among the 21 states, including many in the South, that are currently saying no to Medicaid expansion. Louisiana is another.
Gary Wiltz, the CEO of 10 community health centers in southwestern Louisiana, said demand has surged. “We’ve gone from 10,000 patients to 20,000 in the last six or seven years, so we’ve doubled,” he said.
Wiltz said other things are at play too. The economic recovery hasn’t reached many of the poorest people, and some who do qualify for Obamacare subsidies say their options are still too expensive.
“The need keeps increasing, and I think that’s reflected throughout all the states,” he said.
Wiltz, who also heads the board of directors for the National Association of Community Health Centers, said clinics are packed even in states that expanded Medicaid. After all, most of the clinics treat Medicaid patients too.
The Charlotte clinic’s Nancy Hudson said there’s another part of the health law helping fuel the growth: additional funding for community health centers.
Hudson found out last week her clinic is getting about $700,000 to expand in partnership with Goodwill.
“Many of their clients did not have any access to health care,” she said. “They can’t train and sustain a job if they don’t have the basic needs taken care of, and health care is one of them.”
Nationwide, the federal government estimates its latest round of funding will lead to about 650,000 people getting better access to health care.
This story originally appeared in Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.