New Statistics Show Drops in the Rate of Uninsured
This story was updated at 10:10 am with additional quotes.
By Rose Hoban
Fewer people nationwide lacked health insurance in the opening months of this year, according to new data from the Centers for Disease Control and Prevention released Tuesday. And in North Carolina, the overall rate of uninsurance fell, according to another survey.
The National Health Interview Survey, conducted during the first three months of 2014, found that nationally the uninsured rate dropped from 14.4 percent in 2012 to 13.1 percent in 2013 for people of all ages. The study, performed every year by the U.S. Census Bureau, showed a steady decline in rates of uninsurance rates from a high of 15.5 percent in 2010.
Nationwide, 41 million people still lacked health insurance; more than 99 percent of those people were younger than 65 years old. Very few people over 65 are uninsured, as most of them have Medicare.
The survey found that for the first part of the year, the most pronounced drop in uninsured rates was among young adults aged 19 to 25. That number dropped from 26.5 percent in 2013 down to 20.9 percent in the beginning of 2014.
Since passing, the Affordable Care Act has allowed for young people to be retained on their parents’ insurance until age 26, and other surveys have found many families have taken advantage of this provision. Once people reach 27, however, the rate of people lacking insurance jumps back up.
“We know we had a few hundred thousand people get health insurance on the exchange,” said Dr. Adam Zolotor, interim president and CEO of the North Carolina Institute of Medicine. “We don’t know how many of them had health insurance through the private market the previous year, we know that some number of people did not.”
North Carolina statistics
A separate survey also released Tuesday by the U.S. Census Bureau broke down rates of uninsurance by state. That survey found that in North Carolina, about 1.58 million people were uninsured in 2012. But by the time of the 2013 survey, that number had dropped to 1.509 million. That means that the rate of uninsured in North Carolina dropped from 16.5 percent in 2012 to 15.5 percent in 2013.
However, the census numbers do not include the early part of 2014, which was during the enrollment period for health insurance coverage under the Affordable Care Act, nor do those numbers break down ages of people who gained insurance during the enrollment period. But federal statistics show that at least 95,000 young adults under 26 in North Carolina gained insurance through a family member by the end of 2011.
“The problem with the Census data is that it has very little to do w anything substantive on rates under the Affordable Care Act,” Zolotor said. “it’s a small change and it’s a change that preceded implementation of the ACA; it’s probably more related to the economic recovery.”
Zolotor pointed out that in states which expanded Medicaid, the drop in uninsurance was about 3 percent, whereas in non-expansion states, it was a 1 percent, statistically insignificant decrease.
According to a spokesperson for Blue Cross and Blue Shield of North Carolina, 232,000 people in the state signed up for coverage on the health insurance exchange; 70 percent of those people had not been BCBSNC customers the prior year.
Over all, a total of 357,584 North Carolinians signed up for insurance through the health benefits website in early 2014.
Small Firms Slow to Embrace ACA Business Exchanges
As the online health insurance exchange for small businesses comes online, few businesses are signing up.
By Christine Vestal
Unhappy with the choices her insurance broker was offering, Denver publishing company owner Rebecca Askew went to Colorado’s small-business health insurance exchange last fall. She found exactly what she’d been hoping for: affordable insurance options tailored to the diverse needs of her 12 employees.
But Askew is in a tiny minority. Only 2 percent of all eligible businesses have checked out so-called SHOP (Small Business Health Options Program) exchanges in the 15 states where they have been available since last October under the Affordable Care Act. Even fewer purchased policies.
In November, three more state-run SHOP exchanges are slated to open, and the federal government will unveil exchanges for the 32 states that chose not to run their own.
SHOP exchanges were supposed to open nationwide on Oct. 1, the same day as exchanges offering health insurance for individuals. But the Obama administration postponed the SHOP launch, citing the need to fix serious technical problems with the exchanges for individuals, which it said were a higher priority.
So far, only the District of Columbia and 15 states – California, Colorado, Connecticut, Hawaii, Idaho, Kentucky, Massachusetts, Minnesota, Nevada, New Mexico, New York, Rhode Island, Utah, Vermont and Washington – have launched small-business exchanges. Three more – Maryland, Mississippi and Oregon – will also start their own exchanges.
“It’s easy to explain why [small-business exchanges] have gotten off to a slow start,” said Linda Blumberg, a researcher with the Urban Institute who is tracking their development with support from health care advocates, the Robert Wood Johnson Foundation. The delay of small-business exchanges in most states confused business owners in the few states that actually offered exchanges, she said.
Also, insurance companies encouraged business owners to renew their plans before the October 2013 deadline to avoid having to sign up for a new policy during the first year of the controversial ACA rollout. The Obama administration allowed even noncomplying plans to be renewed, after complaints from individuals and business owners who had received cancellation notices.
As a result, not as many businesses needed to look for new policies for their employees as was originally projected. To be successful, SHOP exchanges must attract a large pool of businesses that can exert market pressure on insurance carriers and ultimately bring down prices. Whether that will happen remains to be seen.
How It Works
The ACA offers businesses with fewer than 50 employees the opportunity to purchase health insurance coverage for their workers through a SHOP, but it does not require them to do so.
These firms comprise 5.8 million of the 6 million firms in the U.S. and employ at least 37 million Americans. More than 96 percent of larger corporations cover their employees, while only 59 percent of very small companies provide insurance for their workers. As a result, nearly half of the nation’s 47 million uninsured people are self-employed or work for a small company, according to 2012 data from the Kaiser Family Foundation.
Under the health law, a federal tax credit that can cover up to half the cost of an employer’s share of premiums is available to businesses that have fewer than 25 employees and average annual wages of less than $50,000. The federal government estimates 4 million small businesses will qualify, resulting in $40 billion in subsidies over the next 10 years.
But so far, not many companies have taken advantage of the offer, according to a report by the Government Accountability Office. In the 2010 tax year, only 170,300 businesses received a credit, amounting to just $428 million, according to the report.
“A lot of folks complained that they needed to hire an accountant to figure it out,” Blumberg said. “You couldn’t even get a rough idea whether you qualified.” Insurance brokers have also complained about how difficult it is to determine eligibility for a credit, and suggest the federal government should create some kind of easy-to-use calculator.
In Colorado, the percentage of people employed by small businesses is even higher than in much of the rest of the country. “There aren’t exactly a lot of corporate headquarters here,” said the state exchange’s chief strategy officer, Marcia Benshoof. “Colorado is a state of small business. We have some very passionate folks here who care about this market,” she said.
A few other states have entered partnerships with the federal government to use the federal website but plan to provide their own marketing and outreach. All states regulate the insurance companies that offer their policies on and off the exchange.
Over the past decade, insurance premiums for small firms have increased 123 percent. Currently, small businesses pay up to 18 percent more than larger businesses for health insurance, according to the Council of Economic Advisers.
The health law requires SHOP exchanges to include a feature known as “employee choice,” in which individual workers can pick from a variety of policies offered by different insurance companies, similar to the menu of health benefit options larger companies offer employees.
“When we talk about why they should use the exchange, choice is the meaningful part of that conversation. That’s the moment of truth with employers,” Benshoof said. Besides creating goodwill, studies show that offering employees a choice of health plans often results in lower overall health care costs, because employees tend to choose the lowest-priced plans that offer the most value for their individual needs, according to the National Bureau of Economic Research.
In Askew’s case, allowing her employees to choose a health plan resulted in an overall decrease in her monthly premium bill. Two of them had chronic conditions and needed more expensive policies that covered the doctors they had been seeing for years. The rest were relatively young and healthy.
“I set a contribution limit [from the company] based on the cost of the most expensive policy and let the staff choose the policy they wanted,” Askew said. Out of 47 choices on the exchange, she said 10 of her employees chose a plan that was cheaper than the $300 per month per person limit she set. Overall, she will pay a total of about $400 per month less than she did last year.
Before Colorado opened its exchange, Askew, like most small employers, could qualify only for one insurance policy for all of her employees. That’s because commercial carriers set a threshold number of employees that must sign up to get a plan. As a result, companies with fewer than 50 employees usually qualify for only one plan.
In June, the Obama administration allowed 18 mostly Republican-led states using the federal exchange to temporarily opt out of employee choice, because they argued it could cause overall insurance rates to rise. Alabama, Alaska, Arizona, Delaware, Illinois, Kansas, Louisiana, Maine, Michigan, Montana, New Hampshire, New Jersey, North Carolina, Oklahoma, Pennsylvania, South Carolina, South Dakota and West Virginia will not offer the feature until 2016 at the earliest.
A small-business advocacy group, the liberal-leaning Small Business Majority, criticized the administration for putting off employee choice, which they say is critical to the exchanges’ success. Without it, state and federal small-business exchanges may not offer businesses any distinguishing advantages over self-insuring or purchasing a policy outside of the exchange, said David Chase, the group’s health policy analyst.
With employee choice, he explained, carriers are selling directly to employees, giving small insurance companies a chance to compete with established carriers. That alone, Chase said, could contribute to eventually dragging down prices on the exchange.
The National Federation of Independent Business (NFIB), one of the groups that sued the administration over the federal health law’s so-called individual mandate requiring nearly everyone to purchase health insurance or pay a tax fine, currently advises its member companies to consider canceling their group health policies and instead help employees apply for insurance subsidies on the individual exchange. According to the NFIB, the total cost to business owners who are now offering workers’ coverage may be lower if they simply give employees a salary boost to purchase insurance on their own.
If a company’s average wages are low enough to qualify for the small-business tax credit, chances are its workers would have incomes low enough to qualify for substantial subsidies on the individual exchange. If workers have an employer offer of affordable insurance, however, they lose their eligibility for premium tax credits.
When it comes to health insurance, the biggest issue for small businesses is cost, according to a recent survey published in the journal Health Affairs. More than 92 percent of small firms that don’t offer employee coverage said that costs would need to be lower than they are today for them to do so. The catch for SHOP exchanges is that until a large number of businesses start purchasing policies on them, they likely will not create enough new competition to push down prices. Other features and extensive marketing will have to drive businesses there in the meantime.
In general, insurance agents and brokers, who have an equal financial incentive to help businesses purchase policies on the exchange as from the outside market, say exchanges have required nearly twice as much of their time. Colorado exchange officials admitted they were surprised that Askew had successfully navigated the exchange without the help of a broker.
“Granted I’m a lawyer,” Askew said. “But it seemed to me to be a much easier way to manage it all.”
Stateline is a nonpartisan, nonprofit news service of the Pew Charitable Trusts that provides daily reporting and analysis on trends in state policy.
Rural Enrollment Presents Continuing Health Law Challenges
By Shefall Luthra
Americans living in rural areas will be a key target as states and nonprofit groups strategize how to enroll more people in health law insurance plans this fall.
Though millions of people signed up for private insurance or Medicaid in the first year of the Affordable Care Act, millions of others did not. Many live in rural areas where people “face more barriers,” said Laurie Martin, a RAND Corp. senior policy researcher. Brock Slabach, a senior vice president at the National Rural Health Association, said “the feds are particularly concerned about this.”
Distance is one problem: Residents have to travel farther to get face-to-face assistance from the so-called navigators and assisters hired to help consumers figure out the process. And Internet access is sometimes spotty, discouraging online enrollment.
But the most significant barriers may stem directly from state decisions about whether to expand Medicaid eligibility – more than 20 states chose not to – and whether to operate their own health exchanges. States that embraced those parts of the law generally had more federal resources as well as funds generated by their online marketplaces for outreach efforts to boost enrollment, including those aimed at consumers in less accessible areas, and more coverage options, through Medicaid, for which these consumers might be eligible.
About $2.5 million from the Department of Health and Human Services was specifically directed to rural outreach for the initial open enrollment period. For 2015, a total of $60 million will be available to bolster navigators’ work in states that are using the federal marketplace, but it’s not clear what portion of this amount will be directed to rural enrollment.
An examination of experiences in Minnesota and Virginia shows how state decisions continue to shape these efforts. Both states have significant rural populations: about 13 percent of Virginians and 23 percent of Minnesotans, according to 2013 figures from the U.S. Department of Agriculture. In 2012, both had rural poverty rates in the teens: nearly 18 percent in Virginia versus 12 in Minnesota. And between 2011 and 2012, about 9 percent of Minnesotans were uninsured, compared to 13 percent in Virginia, the Kaiser Family Foundation reported. (KHN is an editorially independent program of KFF.)
“We’re spread thin throughout the state, but that means in rural areas there are additional challenges in terms of finding the people and getting out to groups,” said Jill Hanken, health attorney at the Virginia Poverty Law Center, the state’s principal navigator agency.
In Minnesota, Ralonda Mason, a supervising attorney at St. Cloud’s branch of Mid-MN Legal Aid – which works as a navigator serving rural and urban areas near St. Cloud – echoed Hanken. Reaching people is difficult, and some areas lack strong Internet, frustrating attempts to use the online exchange.
Last time, consumers sometimes traveled as far as 55 miles each way for assistance, said Allan Bakke, a navigator at Minnesota’s Western Community Action.
But as the 2015 enrollment push approaches, the states are gearing up to try again.
Mason said technology problems still plague the state’s troubled marketplace, MNsure. For instance, the site doesn’t let navigators and consumers use computers in different places to simultaneously log into the application and fill it out over the phone. They must review it in person, which adds to the difficulties distance imposes. Site crashes or application failures, which navigators said they hope to see fewer of this year, add burdens for consumers or navigators already traveling far, Mason said.
Bakke, whose organization serves smaller municipalities – usually fewer than 10,000 people – said the state’s online insurance marketplace has improved. But he remains “very much apprehensive” about the potential recurrence of technical issues this fall.
MNsure is developing rural strategies such as focused marketing to reach the farmers and miners who dominate rural Minnesota, said spokesman Joe Campbell. The state plans to advertise on radio stations that appeal to these populations, he said, while sending representatives to events such as county fairs and farmers markets.
Though official data detailing 2014 enrollment by county would help, Mason said, it’s not a top priority.
A private consortium, supported by the Blue Cross and Blue Shield of Minnesota Foundation, has gathered some information examining where outreach worked. Organizations such as Mason’s that received early grants to promote enrollment have pooled data to paint a more complete picture, pinpointing areas in which to focus and refining plans for November.
In Virginia, meanwhile, groups cited state decisions making enrollment more difficult. Virginia is one of 36 states either defaulting to the federal exchange or in a partnership with the federal marketplace.
Problems with healthcare.gov, the federal exchange site that had a near-catastrophic launch last October, initially compounded the challenge, Hanken said, though many exchange issues abated by December.
But the absence of federal enrollment data by county still undermines planning efforts for November.
The Centers for Medicare & Medicaid Services doesn’t know whether or when it might release enrollment breakdowns examining geography or other demographics, meaning identifying where to target outreach remains difficult, said Massey Whorley, a senior policy analyst at the Virginia-based Commonwealth Institute, a nonpartisan center that examines public policy’s consequences for middle-class and low-income people.
“It’s critically important we have this data well in advance of the next open enrollment,” Whorley said.
For now, Virginia navigators rely on anecdotal evidence, he said, assuming “high pockets of uninsured folks” remain in the rural Southside and Southwestern Virginia.
And unlike Minnesota, Virginia did not expand Medicaid, which would have opened the program to people with incomes up to 138 percent of the federal poverty level.
When the Supreme Court ruled in 2012 that states could opt out of expansion, a coverage gap opened for millions of people who could neither qualify for Medicaid nor the subsidies the law provides for purchasing private plans on federal and state exchanges.
Earlier this year, Democratic Gov. Terry McAuliffe vowed to use executive powers to circumvent the state legislature, which in June approved a budget blocking the expansion. Health-law opponents, who currently make up the majority of lawmakers, say a bigger Medicaid program is likely to burden states with extra costs down the road.
But for now, a quarter of uninsured nonelderly adults in Virginia – just under 200,000 people – fall into this coverage gap, according to a 2014 KFF brief. The data doesn’t parse where, specifically, those people live, but Virginia navigators said they noticed rural areas were hit particularly hard. During the last round of rural outreach, “Sometimes, half of the folks [navigators] saw in offices were in [this] gap,” said Deepak Madala, project manager of Enroll Virginia, a subsidiary of the navigator Virginia Poverty Law Center.
When clients can’t get Medicaid or private-insurance subsidies, Marcie Barnes, a navigator at the rural Southwest Virginia Legal Aid Society, said she often redirects them to free clinics.
“I talked to people who [seemed to think] if they told me how bad it was, I had a magic trick to help them,” she said. “And I don’t.”
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.
Back to School, and Packing that Lunch: A Few Safety Tips
By Benjamin Chapman
My son Jack started kindergarten a couple of weeks ago and our luxurious summer schedule came to an end. No biggie for me, as I’m in the habit of a 5:30 a.m. wake up. (It’s quiet and it gives me an excuse for going to bed at 9 p.m.) But it does mean packing a lunch everyday that will stand up to no refrigeration.
With traditional schools beginning this week and next, packed-lunch food safety is back on the menu for many. Here are the things I try to do to keep Jack’s lunches safe:
Refrigerating the lunch components and freezing juice boxes or water
About half the time, I make Jack’s lunch the night before and refrigerate all the components until about 10 minutes before he leaves. I know it’s going to be about four hours until he opens up his lunch, so I want the starting temp to be low enough to curb the growth of any pathogens (especially if he’s taking his lunch on a field trip). The juice/water ice pack helps with this as well.
Using an insulated bag
Living in the South, the summer heat goes well into October. We purchased an insulated bag that’s built to shield the inside from rising temperatures. Conversely, if we were to provide any hot foods (like soup) we’d add an insulated thermos. The hot food packed for lunch makes me nervous; I’d probably test out the thermos before hand by filling it up with hot food (probably above 165F) and using a digital tip-sensitive thermometer after four hours to see whether it has remained at least above 135F.
Cleaning and sanitizing
We use a mix of one-use and reusable containers for Jack’s lunches. We’re in the habit of putting them directly into the dishwasher when he gets home. I rinse his lunchbox out with water (to take care of any leftover food debris) and then spray it down with a sanitizer, rinse and let it dry.
Instilling good hygiene
After the first couple of days of school, Jack came home requesting to go to the store and purchase a small hand sanitizer for his backpack (peer pressure, since a few of his friends had them). I bought the sanitizer but also reinforced the gold standard of good handwashing (including using a paper towel) before squirting the sanitizer.
I’m still a paranoid new parent and a self-proclaimed food-safety nerd. Beyond what I can control with my son’s lunch, I worry about how the school will handle any food that might be used in the classroom and whether handwashing (for kids and teachers) will be valued. I also hope that the teachers and staff recognize risky events (like a norovirus outbreak) and have the tools to manage illness transmission.
Benjamin Chapman is a food-safety specialist and associate professor in the Department of Youth, Family, and Community Sciences at North Carolina State University. He blogs about food safety at barfblog.
Changes to Block Grants in the General Assembly Budget
We break down the details of this year’s Health and Human Services block grant funding changes.
By Rose Hoban
Every year, many health, human service and social programs are funded by block grants – big pots of money given to state agencies to be used for specific programs.
Large programs such as the Child Care subsidy – with a budget of more than $150 million – are funded in this manner, as well as small ones like the new budget line for mental health crisis initiatives that total about $2 million.
Many block grant dollars come from the federal government, which gives states broad guidelines on how to use the money. Others come with more strings attached.
For the most part, block grant funding stays relatively stable from year to year, but every year, there are changes. Below are the changes contained in this year’s state budget.
|BLOCK GRANT CHANGES|
|Temporary Assistance for Needy Families||TANF funds moved into Foster Care Services: $1,385,152 (new budget line)|
|Subsidized Child Care Program Block grant funds reduced from $57,172,097 to $54,054,806|
|PreK “Swap Out”” $7,195,807 (new budget line)|
|Total TANF funds increased from $306,234,756 to $313,460,826|
|TANF Emergency Contingency Funds||Subsidized Child Care Funds increased from $6,549,469 to $11,679,394|
|PreK “Swap Out” $12,646,527 (new budget line)|
|Total TANF Emergency Contingency Funds increased to $29,932,538 from $12,156,086|
|Social Services Block Grant|
|Expenditures for DSS/Division of Aging and Adult Services||County DSS funds reduced from $29,422,137 to $27,427,015|
|UNC Cares Contract reduced from $229,376 to $57,344|
|Foster Care Services budget line eliminated, moved to TANF above|
|Total Social Services Block Grant reduced from $62,877,557 to $59,325,251|
|Low Income Home Energy Assistance Program|
|Transfers to other state agencies:||Weatherization Program funds reduced from $14,947,789 to $12,473,090 to DENR|
|Heating Air Repair and Replacement program from $7,193,873 to $6,636,633|
|Local Residential Energy Efficiency Service providers for two lines above: increased from total $375,609 to $1,005,177|
|DENR Administration for lines 114, 115: increased from total $375,609 to $1,005,177|
|Total Low Income Energy Assistance Block Grant: decreased from $114,911,848 to $113,139,044|
|Child Care and Development Block Grant|
|Division of Child Development and Early Education||Child Care Services increased from $158,328,747 to $168,536,136|
|Quality and Availability Initiatives increased from $22,500,000 to $24,168,551|
|Administrative budget increased from $6,000,000 to $7,677,977|
|Division of Central Admin||Central Regional Hospital Maintenance $202,000 (new budget line)|
|Total Child Care and Development Services Block Grant: increased from $275,651,161 to $289,407,078|
|Mental Health Services Block Grant|
|Program expenditures||Mental Health Services for adults from $10,717,607 to $0 and for children from $5,121,991 to $3,619,833 – total reduction of $12,219,765|
|Mental Health Services for Adults/ Children: $12,398,643 (new budget line)|
|Crisis Solutions Initiative – Critical Time Intervention: $750,000 (new budget line)|
|Total Mental Health Services Block Grant increased from: $16,039,598 to $16,968,476|
|Substance Abuse Prevention and Treatment Block Grant|
|Division of Mental Health, Developmental Disabilities and Substance Abuse Services||Elimination of “Adult” Substance Abuse Service, Treatment Alternative for Women, Chlid Substance Abuse Prevention and Services budget lines: $32,338 028 total|
|Replacement of above with new budget lines:|
|Substance Abuse Prevention: $8,699,284 (new line item)|
|Substance Abuse Treatment for Children/ Adults: $29,519,883 (new line item)|
|New budget lines for Crisis Solutions Initiative||Walk-in crisis centers: $420,000 (new line item)|
|Collegiate Wellness/ Addiction Recovery: $1,085,000 (new line item)|
|Community Paramedic Mobile Crisis Mgmt: $60,000 (new line item)|
|Innovative Technologies: $41,000 (new line item)|
|Veterans Crisis: $250,000 (new line item)|
|Division of Public Health||Elimination of Risk Reduction Projects and Aid to Counties budget lines: $765,949|
|Replacement of above with new budget line:|
|HIV Testing for Individuals in Substance Abuse Treatment: $765,949|
|Total Substance Abuse Prevention and Treatment Block Grant: Increase from $37,527,700 to $45,184,839|
|Maternal and Child Health Block Grant|
|Division of Public Health||Children’s Health Services decreased from: $8,042,531 to $7,574,703|
|Women’s Health decreased from $8,532,935 to $8,095,148
Increases Carolina Pregnancy Care Fellowship from $250,000 to $300,000 (only change in individual initiative funding)
|DHHS Program Expenditures||Children’s Health Services decreased by $926, Maternal Health by $58, State Center for Health Statistics by $8,257, Injury and Violence Prevention by $4,455|
|Public Health Administration decreased by $20,537|
|Total Maternal and Child Health Block Grant decreased from $18,854,259 to $17,914,411|
|Preventive Health Services Block Grant|
|Program Expenditures||Physical Activity and Prevention increased from: $1,186,142 to $2,034,060|
|Injury and Violence Prevention (Rape Victims Services) increased from: $169,730 to $173,476|
|Division of Public Health||Laboratory Services – Testing, Training and Consultation, increased from $10,980 to $21,012|
|State Laboratory Services – Testing, Training and Consultation: $199,634 (new line item)|
|Heart Disease and Stroke Prevention increased from $162,249 to $189,693|
|Performance Improvement and Accountability increased from $213,971 to $738,784|
|Physical Activity and Nutrition increased from $38,000 to $68,073|
|State Center for Health Statistics increased from $61,406 to $107,291|
|Total Preventive Health Services Block Grant increased from $2,234,233 to $3,921,778|
|Community Services Block Grant|
|Office of Economic Opportunity||Community Action Agencies increased from $22,402,724 to $24,168,417|
|Limited purpose agencies increased from $1,244,596 to $1,342,690|
|Administration||Office of Economic Activity increased from $1,244,596 to $1,342,690|
|Total Community Services Block Grant increased from: $24,891,916 to $26,853,797|
Expert: Insurance Pain Coming for NC Businesses, Workers
By Ann Doss Helms
Employees can expect to see more high-deductible health policies as employers try to control costs, a health researcher and former journalist told members of the Charlotte Chamber Friday.
And North Carolina’s economy will suffer from state lawmakers’ decision not to take federal money for Medicaid expansion, said Ceci Connolly, managing director for PricewaterhouseCoopers’ Health Research Institute.
“It’s not a political commentary,” said Connolly, a former health correspondent for the Washington Post and author of a book on the Affordable Care Act. “It’s pure dollars and cents.”
Connolly was a keynote speaker at the Charlotte Chamber’s health care summit, which drew about 450 people to the Westin Hotel. The event marked the chamber’s Healthy Charlotte fitness campaign and its push to market Charlotte as a national health care destination for patients and businesses.
Hospitals, doctors’ offices and other health care businesses employ more than 116,500 people in the Charlotte region and generate more than $6.2 billion in annual wages, the chamber reported.
But Connolly said those businesses lost out on “a serious revenue opportunity” when the state refused the Obamacare offer to expand Medicaid coverage for low-income residents with federal money. North and South Carolina are among 21 states that opted not to participate this year, leaving 689,000 low-income N.C. residents in a “Medicaid gap” without coverage.
“Your industries are suffering because you’re not getting the increased business,” she said.
Fellow panelist Georges Benjamin, executive director of the American Public Health Association, agreed that this wasn’t a smart business decision: “Business people know the first principle of business is not to leave one dime on the table.”
Benjamin, a physician and former Maryland health secretary, told the chamber crowd that federal Medicaid money could have been used to improve mental health services, a need described earlier in the session by John Santopietro of Carolinas HealthCare System. “The beauty of Medicaid is it is run by the states,” Benjamin said. “They can do this. The governors can be creative.”
Several local speakers talked about efforts to control health care costs while improving care. Connolly said she expects to see employers take a leading role in coming years. One likely strategy, she said, is a continuing shift to high-deductible policies that hold down premiums by requiring patients to pay a bigger chunk of medical bills from their own pockets. Such policies force employees to think about spending their own money more wisely, Connolly said.
Technology is likely to play a role in helping patients take charge of their own health, from insurance companies offering online cost comparisons to a burgeoning industry in devices that monitor vital signs and exercise, several speakers said.
Connolly, who was wearing a wristband that monitors her steps, said she envisions a day when that data would feed to her doctor’s office so the doctor would be aware of changes in activity.
Survey: Insurance Rates Lag in Health Law Holdout States
By Eric Whitney
A Gallup poll released Tuesday says that the Affordable Care Act is significantly increasing the number of Americans with health insurance, especially in states that are embracing the law. It echoes previous Gallup surveys, and similar findings by the Urban Institute and RAND Corp.
The latest Gallup survey found that, nationwide, the number of uninsured Americans dropped from 18 percent in September 2013, to 13.4 percent in June 2014. States that chose to follow the ACA’s provisions most closely, both by expanding Medicaid and establishing their own new health insurance marketplaces, as a group saw their uninsured rate drop nearly twice as much as states that declined to do so.
“Those states that have not embraced those two major mechanisms have had about half of the decline in uninsured,” said Gallup’s Dan Witters. “So there’s a clear difference in the states that have implemented those mechanisms versus those who haven’t.”
North Carolina’s rate of uninsurance dropped 3.7 percent from 20.4 percent to 16.7 percent, according to the survey. North Carolina did not expand Medicaid. Arkansas saw the biggest decline in its uninsured rate, from 22 percent to 12 percent. Kentucky, Delaware and Colorado also saw significant declines.
“To drop 10 percent in the uninsured rate within really just six months is really an incredible achievement,” said Arkansas Surgeon General Dr. Joe Thompson. Thompson lobbied for his state’s unique, bipartisan Medicaid expansion, which uses federal funding to buy private insurance for low income people. He says about 80 percent of those with new, private insurance in Arkansas purchased it with Medicaid subsidies.
“Clearly we are having an impact that benefits our citizens,” said Thompson. “Those other states that have chosen not to make something good happen out of the Affordable Care Act are missing that opportunity on behalf of their citizens.”
Among the states that didn’t expand Medicaid or set up their own exchanges are Georgia, Indiana and Mississippi, all of which saw their uninsured rates drop less than 2 percentage points.
Sam Mims, a Republican state legislator from southwest Mississippi, said the Affordable Care Act is still not the right way to go for his state.
“Access to health care is not expanding Medicaid,” Mims said. “I still believe Mississippi cannot afford it for several reasons. Mainly from a financial standpoint we simply cannot afford to expand Medicaid and we will not expand Medicaid.”
He said the legislature is taking steps to expand access to health care, such as allocating more money to federal clinics, expanding mental health clinics and working on programs to get more doctors and dentists to the state.
Not every state that expanded Medicaid saw big drops in the percentage of uninsured. Massachusetts and Hawaii saw declines of less than 1 percentage point, for example. Gallup’s Witters said that’s because those states already had very low uninsured rates prior to the ACA. California, which fully embraced the law but has a higher number of uninsured than any other state, saw a decrease of 5.3 percentage points in its uninsurance rate, according to the survey.
Kansas saw its uninsurance rate pop up by 5.1 percentage points, and Virginia and Iowa also saw slight increases in their uninsurance rates that were within the poll’s margin of error of plus or minus 1 to 2 percentage points.
The telephone poll was part of the Gallup-Healthways Well-Being Index, and it included more than 178,000 people interviewed in 2013 and more than 88,000 people surveyed in the first half of 2014.
Jeffrey Hess of Mississippi Public Broadcasting contributed to this report.
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.
Legislature Will Hold Coal Ash Bill Until November
By Gabe Rivin
The General Assembly will wait until November to try to pass a bill that addresses coal ash, a toxic byproduct of coal-fired electricity that has contaminated subsurface water across the state.
Gov. Pat McCrory will have to wait until at least November to sign coal ash legislation. In the meantime, he issued an executive order Friday afternoon to hire personnel and begin groundwater assessments at the state’s 14 coal ash sites.
Legislators, delayed by a lengthy debate on the state’s budget, left little time to finish their work on coal ash. Instead, they will return for a special session in November. In that session, they’ll attempt to finish work on coal ash and a reform of the state’s Medicaid system.
A bill to address coal ash had been a high priority among legislators during this year’s short session, which began in May and will end Saturday. The February spill of coal ash into the Dan River galvanized members of both chambers, who watched as an estimated 39,000 tons of ash turned the Dan a pale gray.
The Senate passed its version of a coal ash bill on June 25, and the House passed its version on July 3. Both bills would require Duke Energy to close its 33 unlined ash ponds by 2029.
Both chambers’ bills have been controversial among lawmakers and environmentalists. The House’s bill, for instance, contains a provision that some said would undermine a judge’s order that Duke immediately clean up its groundwater contamination. The House bill would also allow Duke to request an extension for the closure of its sites, a provision that was not included in the Senate’s bill.
The two chambers had been negotiating a compromise bill for several weeks in a conference committee. But that work fell apart, according to Senate leadership, after three of the four House conferees tried at the last minute to insert new legislative language.
“This last-second surprise provision had not been researched, vetted or debated by the 167 other legislators,” said a press statement from Sen. Phil Berger (R-Rockingham), the Senate’s Pro Tempore, and Sen. Tom Apodaca (R-Hendersonville), the chairman of the Senate’s Rules committee.
Environmentalists said that Duke is already obligated to clean up the contaminated groundwater near its ash ponds and that the new legislation would allow the utility to delay its work.
“State environmental officials don’t need any additional action from the legislature to allow them to demand a comprehensive cleanup that stops the rampant pollution of rivers, streams and groundwater, and leaves communities at risk,” said Amy Adams, an organizer with the environmental group Appalachian Voices, in a press statement.
The N.C. Department of Environment and Natural Resources, in fact, has sued Duke, citing current law that requires Duke to clean up contaminated groundwater.
Coal ash is produced when coal is burned for fuel. For decades, Duke has stored its ash in unlined ponds. Those ponds have leached the ash’s elements into groundwater, which nearby residents rely upon for drinking water.
The ash contains a number of toxic constituents that are known to harm humans.
The General Assembly’s debate over coal ash has at times been bitter. In the House, members fought to classify their districts’ ash ponds as highly hazardous, which would have required Duke to close those ponds first.
In the end, both chambers’ bills only classified four sites as high risks, leaving a new commission to approve designations for the remaining 10 sites. The environmental requirements, and the deadlines to close the sites, would depend upon the sites’ classifications as low risk, medium risk or high risk.
Autism Insurance Bill Likely to Die in Session’s Final Days
A bill that would allow children with autism to get health insurance coverage for treatment that passed the House over a year ago looks like it won’t make it across the finish line in the current General Assembly session.
The bill, which would require treatment called applied behavioral analysis to be covered by insurers, was passed by the House of Representatives in May of last year.
Applied behavioral analysis has been shown by research to be one of the most effective treatments in helping children with the disorder to be “mainstreamed” into schools and society.
ABA is covered in more than 35 states, including South Carolina, but North Carolina lags behind.
According to the Centers for Disease Control and Prevention, one in 68 children are diagnosed with autism spectrum disorder, and it’s almost five times more common in boys than girls.
After pushing unsuccessfully both last year and this for Senate movement, House lawmakers rolled the provision into SB 493, a 46-page regulatory reform bill that was referenced to committee after passing the second and third reading in the House.
Advocates had hoped the autism insurance provision would be included in the final budget; but with the release of last night’s document, their hopes were dashed.
“We’re very saddened by that, to be honest with you,” said Jennifer Mahan, vice president for governmental affairs for the Autism Society of North Carolina.
“The services that have demonstrated efficacy are behaviorally based,” said Susan Hyman, a researcher from the University of Rochester in a video interview published today on MedPage Today. She said one recent study demonstrated that “naturalistic” services, such as ABA, which takes place in the home and would have been covered by the bill, are the most effective at helping children with autism.
“We know from new data that’s been published that children who have optimal outcome are diagnosed earlier … and have earlier access to evidence-based behavioral service,” Hyman said.
Mahan said the lack of action has been “incredibly disappointing” for families who have kids who would benefit from getting the coverage.
“It’s looking like it’s not going to happen. I don’t say it won’t happen until everything’s over and the gavel falls,” Mahan said. “But it’s not looking good right now.”
Health Care Budget Briefs: Epi Pens, Tanning Beds, Raise the Age
By Jasmin Singh, Hyun Namkoong, Rose Hoban
As lawmakers worked behind closed doors this week to put the finishing touches on this year’s budget revision, health care advocates and lobbyists were walking the halls, holding conversations with key lawmakers where they could. They were hoping to induce movement on a number of bills that have been parked in obscure legislative committees, some for more than a year.
The final budget bill includes some of the measures of concern to health care lobbyists, but some came away disappointed.
School epinephrine pens
A bill passed by the House last year would have provided for schools to supply epinephrine auto-injector devices in every school.
The devices allow for quick treatment of severe allergic responses, whether it be to a peanut or the venom of a bee sting. The most serious kind of reaction is called anaphylaxis, a rapid onset of hives, throat swelling and low blood pressure. Untreated, anaphylaxis can quickly proceed to death.
The budget released late last night includes a provision to have schools obtain epinephrine injection devices and train several staff members in how to use them in case of an emergency. An earlier version of the budget introduced by the House included the same provision.
The original bill was one of many sponsored by Rep. Jim Fulghum (R-Raleigh), a physician who died earlier this month from complications due to cancer.
Youth skin cancer prevention
Another bill co-sponsored by Fulghum last year and passed by the House would restrict teens under 18 years old from using tanning beds – a measure legislators were convinced would reduce the number of premature cases of skin cancer.
Initially, the bill faced stiff resistance from the tanning bed industry, but the industry has since withdrawn opposition to the bill.
This bill is a response to the growing number of skin cancer cases in the country’s youth. The Centers for Disease Control and Prevention reports that in 2012, 61,061 people in the United States were diagnosed with melanomas of the skin – 35,248 men and 25,813 women. The research also shows that young people who begin tanning before the age of 35 have a 59 percent higher risk of melanoma, the deadliest form of skin cancer.
Nonetheless, the measure has been languishing for more than a year, and it looks less likely that tanning bed regulation will become law at the end of this legislative session.
Initially, the bill was standalone, but after a year of inaction by the Senate, House budget writers wrote the provision into their version of the budget. That bill stalled, and House lawmakers then rolled the tanning bed bill into a larger regulatory reform bill, SB 493.
In a recent version of the budget, the statutory language banning teen use of tanning beds was included; but in the final version released late Wednesday evening, the language was gone.
“It’s a sad irony that we received the news about the North Carolina tanning bed bill the same week as the U.S. Surgeon General issued a national call to action on skin cancer,” wrote Brent Mizelle, head of the N.C. Dermatology Association, in a statement Thursday morning.
Raise the age
Historic legislation that would allow 16- and 17-year-olds to be charged as minors rather than adults in the criminal justice system passed the House in May after failing multiple times in the past decade.
But almost two months after overwhelmingly passing muster in the House, the bill continues to languish in the Senate. Advocates and lawmakers in favor of the bill argue that North Carolina juveniles are unfairly subjected to the negative economic impact of a criminal record.
They also point to findings from the National Prison Rape Elimination Commission that show that 16- and 17-year-olds placed in adult prisons have the highest risk for sexual abuse, more than any other group of incarcerated people.
Advocates worried privately that the troubles resolving the budget would result in the bill remaining stuck in the House. But they said they were determined to return to Raleigh next year to keep pushing for the measure.