NC Association County Commissioners

Shows text supporting Medicaid expansion that reads: The Graham County Commissioners strongly give their full support to Representative Kevin Corbin for House Bill 655... The Graham County Board of Commissioners understand that the majority of uninsured inividuals in North Carolina are employed, but do not make enough money to afford health insurance coverage."

Business leaders, conservatives across state warm to Medicaid expansion

October 3, 2019 by Rose Hoban

Business leaders, conservatives across state warm to Medicaid expansion - North Carolina Health News

In private, and increasingly in public, some are making their support for House Bill 655, which would allow for Medicaid expansion in North Carolina, in defiance of the state party leaders.

By Rose Hoban

Dale Wiggins thinks it’s time. Actually, he thinks it’s past due.

Wiggins, a retired businessman, is the head of the Graham County Board of Commissioners, which recently sent a resolution of support for expanding the state’s Medicaid program to legislative leaders and Gov. Roy Cooper.

The unanimous resolution, signed by four Republicans and one Democrat, throws local support behind House Bill 655, which recently passed through the General Assembly’s House Health Committee and awaits a vote on the House floor.

The bill would use the Affordable Care Act to extend the Medicaid program to provide health insurance coverage to many low-income workers who currently don’t qualify for the program.

1920px-Map_of_North_Carolina_highlighting_Graham_County.svg — You can’t get much further west in North Carolina than Graham County, two-thirds of which is made up of the Nantahala National Forest. There are about 8,700 residents, with a median household income of $37,748, according to the NC Department of Commerce. Image courtesy: Wikimedia Commons

“We’ve got people here that literally can’t afford to be sick, they’re living from paycheck to paycheck,” Wiggins said in a recent phone conversation. “If a parent gets sick, loses a couple of weeks work, you know, they could potentially lose a car and lose a home. You know, so there’s a sense of urgency, at least in their lives.”

In a scathing letter (see attached below) sent to Senate leader Phil Berger (R-Eden), Wiggins explains why his board told their local representative Kevin Corbin (R-Franklin) to vote for the bill.

“You know Senator Berger for some people who have good paying jobs and good health insurance it is easy to say that those without insurance just need to go to work isn’t it?” he wrote. “The reality is in places like Graham County those people are working.”

When asked about Wiggins’ letter, Berger’s press aide Pat Ryan responded, “Everybody is entitled to express their opinions on matters before the state legislature, and Senator Berger appreciates the thoughtful feedback Mr. Wiggins provided in his letter. Feedback is always welcome.”

Upwelling of support

The feedback from commissioners, business leaders, economic development experts and other conservatives across the state is that they’re reaching a conclusion similar to Wiggins’. In the past few months, reliably conservative Republican boards and business leaders have been making it known publicly and privately that they think it’s time for North Carolina to follow in the footsteps of 34 other states and the District of Columbia and get low-income workers covered.

It’s a policy that’s long been opposed by the state GOP.

Usually, Medicaid is limited to low-income children, a small number of their parents, pregnant women and seniors in financial need. But the Affordable Care Act opened the door for states to add low-income workers who make too much to qualify for the program but too little to qualify for subsidies to purchase health insurance on the online marketplace.

In North Carolina, individuals making between about $6,120 and $16,860 have been caught in this “coverage gap,” even as lawmakers in other states have extended the benefit to their low-income workforce. The federal government has committed to paying 90 percent of the cost, more than the usual two-thirds of the cost for regular Medicaid patients.

After almost seven years, the data supporting the benefits of Medicaid expansion to states and individuals are becoming overwhelming. In August, the Kaiser Family Foundation published a review of 324 studies that show “improved access to care, utilization of services, the affordability of care, and financial security among the low-income population.”

Research also overwhelmingly shows that expanding Medicaid saves states money, even as it stimulates health care spending, producing a widening circle of economic benefits. For example, in states that have expanded, fewer rural hospitals closed than in states that didn’t.

a woman gestures as she talks to a much taller man. They're talking about Medicaid expansion. — Former GOP gubernatorial candidate George Little speaks to NC Health News editor Rose Hoban after a business roundtable meeting in Pinehurst in August. Photo credit: Jill Hammergren

Those are some of the reasons conservative stalwarts such as Alamance County Sheriff Terry Johnson and former GOP gubernatorial candidate George Little have come out in favor of expansion.

“You’ve got to do something for people,” Little said in an interview with NC Health News this summer. He believes the party as a whole is coming around, and he’s talking to his friends in the senate.

“It’s the economy, and seeing people … It’s the need,” he said.

Tourist economies

“We have one count that tells us that over 6,000 people in Carteret County are without health insurance,” said Tom Kies, president of the Carteret County Chamber of Commerce. “Our free clinic, Broad Street Clinic, puts the number at 1 in 4 people in Carteret County with no health insurance.”

Carteret County is known for its conservatism, along with the beach communities where people working in the tourism industry lack steady year-round income.

“People who are working two or three part-time jobs, just to pay the mortgage, working to pay the rent, they can’t afford health insurance,” Kies said. “And they make too much money for Medicaid.”

Because it’s such a conservative area, Kies said he was surprised to get a positive response to the idea of supporting expansion. The Chamber voted to send resolutions of support to House Rep. Pat McElraft (R-Emerald Isle) and Sen. Norman Sanderson (R-New Bern), he said.

Hurricane Florence really helped a lot of people change their tunes, Kies said.

“We saw that divide between the folks, between the haves and the have-nots in this county become much more pronounced,” he said. “We actually lost a lot of folks who were working those part-time jobs and the restaurants and the hotels and the rental companies.”

Now, the struggle is to keep the workers they have, he said.

“If we have these people who are working, we want to try to keep them healthy,” Kies said. “These workers are like gold right now.”

Understanding the importance

Carteret’s chamber isn’t alone in throwing their weight behind HB 655. NCEast Alliance Chambers, a group partnering with chambers in 13 eastern counties (including Carteret) has also endorsed the expansion of health insurance that would come with HB 655.

“They haven’t specifically said, expand Medicaid,” said John Chafee from the organization. “They said we wanted to expand the reach of health insurance for more people.”

What gradually moved many people, Chafee said, was hearing about friends and neighbors unable to purchase insurance, about people who went without and then got sick.

Chafee has been in economic development for more than four decades, he also argued the insurance problem holds back entrepreneurship in eastern North Carolina.

“I’ve heard instances in terms of where people said, ‘Well, you know, I might have been interested in going out and starting a company, but I didn’t want to lose my health insurance,’” he said.

Finally, he said the NCEast Alliance members started to understand the importance of extending insurance to more people, and what that would mean to the hospitals in the area.

“So you’ve got a number of different stories that come at you as to what motivates people to maybe finally respond and say, ‘Well, maybe that’s not such a bad thing. Because it would help an awful lot of people,’” he said.

‘Big loser’

The more people get beyond the rhetoric of opposing Medicaid expansion, the more they support it, said Sophia Paulos, the economic development director for Graham County. She said that when her commissioners heard how 600 Graham County workers would qualify, that the county would gain about $44,000 in tax revenue and the policy would spur almost a million dollars in economic growth per year, the decision to support it became a “no brainer.”

She’s also come to realize that it wasn’t Obamacare, per se, that caused people’s premiums to rise. Instead, the problem was people’s lack of coverage.

“They show up at the ER, and they’re in some kind of catastrophic health situation and now they can’t pay, because they have no semblance of insurance, they’re never going to be able to pay that bill. And so your premiums just went up because that’s how we afford to keep the hospital open,” she said. “And when I explain that to people, they were like, it made sense.”

The information helped change Wiggins’ mind too.

When Berger wrote back to Wiggins saying that “Medicaid expansion has busted budgets in other states, and studies show that Medicaid is an inefficient and ineffective government program that fails to improve health outcomes,” he fact-checked him.

A man in a suit hands out papers to people sitting in chairs with laptops, some television cameras are also in the room. Brger has long opposed Medicaid expansion. — Senate leader Phil Berger (R-Eden) hands out information during a press conference in June, 2019. Photo credit: Rose Hoban

“You know, in today’s world, it’s as easy as picking up your laptop or go to your computer and Google ‘What’s Medicaid expansion done in other states.’ You know, you get page after page that comes up, and they’re all highlighting all the good things that have happened,” he said. “You have to search multiple pages to find somebody that’s unhappy with Medicaid expansion in their state.”

He said that he doesn’t care what the national, or even the state party said he was supposed to believe.

“These people who need this assistance, who need this medical care, are people I know. They’re my neighbors, they’re my friends. So how can I go look them in the eye and say, ‘You know, the party says that we can’t support this, I’m not gonna support it,’” Wiggins said. “All the statistics bear out the fact that North Carolina has been a big loser.”

Correction: This story originally misidentified the photographer of the picture taken by Jill Hammergren.

Sen Barringer stands at podium with crowd of serious looking people beside and behind her.

NC Lawmakers Propose Full Foster Care Reform

April 6, 2017 by Taylor Knopf

NC Lawmakers Propose Full Foster Care Reform - North Carolina Health News

Several senators want to overhaul North Carolina's child welfare system, which received failing grades in two reviews last year.

By Taylor Knopf

North Carolina’s foster care system is inadequate at best and a nightmare at its worst. That was the assessment by not just federal regulators last year, but also a private consulting firm which performed a review that found the system severely lacking.

Lawmakers hope to change that with the Child/Family Protection and Accountability Act, which aims to fully reform the state Division of Social Services by 2022.

Senate Bill 594 would establish a “working group” of county commissioners, social services workers from state and county departments, court officials, attorneys and other concerned professionals who would be tasked with re-organizing county social services. This bill would set up no more than 30 regions by 2019, which would replace the current model, where social services are controlled at a county level throughout the state.

“North Carolina is in the midst of a child welfare crisis,” said primary bill sponsor Sen. Tamara Barringer (R-Cary), during a press conference Wednesday at the General Assembly.

Barringer, a former foster parent, explained that North Carolina has seen a 25 percent increase in children entering foster care in the last five years. The system is overwhelmed, she said, and lacks a basic computer system to manage caseloads. She said there’s no consistent model of care, which is delivered by a disjointed system of 100 separate county agencies.

Last year, the federal Children’s Bureau reviewed the state’s system and found that North Carolina’s child welfare system did not meet standards in all seven types of outcomes measured, such as safety from abuse. The state also failed in all of the systems measured, such as how consistently staff were trained.

Earlier this year, the North Carolina State Auditor, Beth Wood, found that county social services across the state struggle to sign up Medicaid recipients in a timely and accurate fashion. After auditing about 2,000 cases in 10 counties across the state, reviewers found that high staff turnover, a steep learning curve for operating state computer systems, and a lack of supervision contributed to problems at county social service agencies.

This new bill calling for statewide foster care reform is supported by Republicans and Democrats in both the House and Senate, and they want to act now. Barringer said she intended to “fast track” the bill.

“How many times do we have to be told we are failing before we will do something?” Barringer asked. “How many more times will children disappear and us not know what’s going on? How many times are we going to accept that children actually die in this state because they are not properly placed and supervised, and we are failing to give them the services they need.

“Children deserve a family, not a system,” Barringer added later. “And the system we have is failing our children.”

Rep. David Lewis (R-Dunn), the powerful House Rules Committee chair said the bill is a priority for the House. He co-sponsored a companion bill in the House of Representatives.

Annual Mental Health Breakfast Assembles Advocates, Service Providers and Elected Officials

January 27, 2015 by Editor

Annual Mental Health Breakfast Assembles Advocates, Service Providers and Elected Officials - North Carolina Health News

Medicaid expansion and reform is a topic of spirited discussion at the mental health care community’s annual gathering in Chapel Hill.

By Taylor Sisk

The mental health advocacy community rallied this past weekend in preparation for this year’s General Assembly session. Some 300 people turned out at the William and Ida Friday Center for Continuing Education in Chapel Hill Saturday morning for the 37th Annual Legislative Breakfast on Mental Health.

Attendees heard from elected officials, service providers, family and consumer advocates and the state Department of Health and Human Services’ Assistant Secretary for Mental Health, Developmental Disabilities and Substance Abuse Services Dave Richard.

Ronnie Beale (left), president of the state Association of County Commissioners, and Dave Richard, assistant secretary for mental health, developmental disabilities and substance abuse services, confer after the Legislative Breakfast on Mental Health. Photo credit: Taylor Sisk

This year’s theme was “NC Mental Healthcare: Crisis, Discrimination & Solutions.”

The proceedings began with a panel presentation from Charlene Lee, Troy Manns, Madison Baldassari, Shannon Lachot and Steve Bailey, sharing stories of either their own recovery or that of a family member.

Special guest speaker Ronnie Beale, president of the state Association of County Commissioners and a Macon County commissioner, then offered a lively address with some self-deprecating humor: “Don’t let my New York City accent fool you, I’m from North Carolina,” he said in the distinctive cadence of the Western North Carolina mountains.

Beale then launched into an impassioned defense of the need for more, better and more easily accessible mental health care services, calling upon the legislature to restore lost money and beds.

Richard, the morning’s keynote speaker, addressed discrimination, saying, “We have to make sure that lay leaders, school leaders, people in our faith communities understand mental illness and mental health needs.”

“We’ve got to stop talking about reducing stigma,” Richard said. “We have to talk about eliminating stigma.”

‘Take ahold of your seats’

Medicaid reform and expansion then took center stage in a town hall-type forum that included several legislators.
Asked about revamping the state’s Medicaid system, Rep. Marilyn Avila (R-Raleigh), who sits on the Joint Legislative Oversight Committee on Health and Human Services, said, “I’m going to ask everyone to take ahold of your seats. Because as we’re discussing it right now, I hope it doesn’t take place. And I’ll tell you why.

Dave Richard addresses attendees of the Legislative Breakfast on Mental Health. Photo credit: Taylor Sisk

“The issue is not how you administer the programs but what you do with the programs.”

The tendency of government, Avila said, is to “consolidate and standardize” a program to make it “easy and efficient for government, not necessarily the people it serves.”

She said the state should promote collaborations that focus on outcomes and not be concerned about how they’re administered and “who calls the shots.”

She praised Community Care of North Carolina, saying it provides “good, integrated care.” CCNC is a not-for-profit statewide network of primary care providers that focuses on preventive measures and continuity of care. The program receives state money to coordinate care for many of the state’s Medicaid patients.

Another featured speaker, Sen. Mike Woodard (D-Durham), cued up a discussion of Medicaid expansion in his remarks, saying, “It ain’t gonna happen” because the current legislative leadership won’t consider it.

Rep. Paul Luebke (D-Durham) drew applause when, as a participant on the town hall forum, he said he felt it was important to acknowledge that the leadership of the House and Senate and the governor “still are not accepting Medicaid expansion under the ACA. They won’t do it.”

“It hurts so many people,” Luebke said. “It’s just wrong that our House and Senate leadership under the Republican Party is not doing the right thing.”

Sen. Fletcher Hartsell (R-Concord), also a member of the Joint Legislative Oversight Committee on Health and Human Services, responded, stating, “Unless and until we develop an overall system that is based on health – not on sick care, not on physical versus mental – and create payment reimbursements in such a way that they are associated with outcomes, nobody’s going to be successful.”

“The problem is coming up with systems that have effective outcomes and mechanisms by which providers can be paid, in effect, what they’re worth and what they provide and what they’re successful with,” Hartsell said.

‘We can do better, folks’

In his opening address, Ronnie Beale had sounded a unifying theme.

More than 300 people spent their Saturday morning at the breakfast, which featured a panel that included lawmakers, a district attorney, several people with mental health disabilities and psychiatrist. — More than 300 people spent their Saturday morning at the breakfast, which featured a panel that included lawmakers, a district attorney, several people with mental health disabilities and a psychiatrist. Photo credit: Rose Hoban

“We have opportunities,” he said. “We know where the problems are. We have the people to fix them…. We can do better, folks, by working together.”

Beale then underscored the gathering’s emphasis on ending discrimination.

“One of these days, somewhere, sometime, when you see [a flier like this],” he said, holding aloft a hand-printed sign, “you’ll know we’ve made progress. It’s going to be in your church bulletin, it’s going to be on your convenience store door, it’s going to be somewhere.

“Here’s what it’s going to say: ‘Benefit for Ronnie Beale. On any Saturday night at your local school. Hot dogs, hamburgers, chips, cakewalk options…. Come help with our friend who suffers from severe mental health issues.’

Until you see such a flier, he said, one that speaks as openly of mental health issues as we do of other maladies, “folks, we’ve not made much progress.”

This drew perhaps the loudest applause of the morning.

Seniors Worry about How Budget, Tax Plans Could Affect Them

June 21, 2013 by Rose Hoban

Seniors Worry about How Budget, Tax Plans Could Affect Them - North Carolina Health News

Between the competing tax plans and the budgets being debated in the General Assembly, seniors and their advocates fear cuts and new taxes could adversely affect them.

By Rose Hoban

As a younger man, David Marshall did everything right in order to be comfortably retired. An engineer, he worked for a big corporation; then the corporation pushed him out of their pension plan and into the stock market to cover his retirement.

He used some of his retirement money to start his own business; it was successful, and he passed it along to his son. He and his wife downsized into a single-story house in North Durham that he owns. His car is paid off.

Then the stock market crashed in 2008, and he lost a lot of what he had invested.

Marshall is still comfortable, netting about $1,350 a month from Social Security and an annuity and getting a little help from his son, when his son can afford it.

maps show the changing number of people over 65 in each county. — Map progression shows the changing number of people over 65 in each county. Although people under 65 can contract Alzheimer’s’, age is the greatest risk factor for the disease.

Nonetheless, Marshall, 76, still works two days a week at a hardware store, where he makes about $4,000 a year. And that helps make ends meet.

“It’s hard, and as the economy and the cost of living escalates, it becomes harder,” Marshall said. “But if you start fiddling with my pensions and Social Security, it’d make life difficult.”

That’s why Marshall has his eye on the competing budget and tax plans that are in play in the General Assembly now – because many of the decisions made by lawmakers in the coming weeks could have profound effects on seniors.

‘Not well-informed’

One of the biggest blows potentially comes to the Home and Community Care Block Grant, a federal grant that provides for many social services.

According to Wendy Marsh, director of the Council of Aging in Buncombe County, her agency uses that block grant money to provide a laundry list of services and activities: hot meals at the senior center for hundreds of people each month, adult day care for dozens, Medicare counseling and advice, installing ramps and grab bars in bathrooms, rides to the doctor – the list goes on.

“A lot of that is funded by the block grant, and that was hit by the sequester,” Marsh said, explaining that the federal sequester cut about $2 million from the state’s federal allocation of the block grant for the coming fiscal year.

Marsh is concerned that both the House and Senate budgets cut the block grant money even more: the House by $500,000 and the Senate by $2.9 million. Both chambers’ budgets would move that money into Project CARE, a program to provide respite for families caring at home for someone with dementia.

“It’s a well-intentioned move; it’s not a well-informed move,” Marsh said.

Across the state, 16,000 people are on waiting lists for meals delivered at home, such as Meals on Wheels, said Mary Bethel, lobbyist for the AARP. And other services have been trimmed, even as the aging population begins to balloon.

“When you look at the population now, the people who are 65 and over are 1.3 million. In 20 years, it’s going to be 2.3 million,” Bethel said. “You have 7,000 fewer people being served today than 10 years ago.

“If we’re already falling behind and you can’t fund these services to keep someone in a home, the chances are that they end up in a nursing home.”

Bethel said people who wind up in nursing homes because they can’t stay at home end up “spending down” all of their assets, and then can qualify for Medicaid to pay for the care. So the state and federal government end up paying, but paying for much more expensive care.

In 2010, about 11 percent of Medicaid beneficiaries were elderly people in nursing homes; their care took about 20 percent of the Medicaid budget, according to figures from the Kaiser Family Foundation.

But baby boomers are about to start retiring, Bethel reminded, and the need for ways to provide long-term care will only grow.

“If you ask people where they want to live when they’re 90, they don’t say I want to be in a nursing home. They want to be at home,” said Marsh. “But they need help staying at home.”

Competing tax plans

Social Security benefits for some higher-earning seniors could be taxed under the plan proposed by the state Senate, while the House keeps Social Security untouched.

But even if neither House touches Social Security – which is considered a politically risky move – some reductions in revenues for counties and municipalities could end up trickling down to seniors, Bethel said.

The Senate plan passed on June 13 would reduce counties’ ability to levy local sales taxes on food and reduce the sales-tax refund for counties.

“That’s about 13 percent of our sales-tax base,” said Rebecca Troutman, who represents the N.C. Association of County Commissioners at the legislature.

The Senate plan would allow counties to hold a vote to restore up to a 2 percent tax on food back into existence, “but that seems a redundant exercise, because we’ve already levied the tax on food since the ’70s,” Troutman said.

Troutman said counties provide important social services for seniors, such as protective services.

“We’re responsible to do all investigation of complaints of abuse or neglect for the elderly, just like we are with children,” she said. “There was nothing in the budget proposals that would take money directly away from counties for that function, but it’s mainly county dollars.”

The Senate plan would cost counties about $82 million, according to Troutman. The House plan is more favorable to counties; by the 2018 when the sales tax is fully implemented counties could net an additional $74 million in taxes.

If counties lose money under the tax plan, Troutman said there are ways to make up revenue. <http://www.ncacc.org/index.aspx?nid=336>

“We could increase property taxes or cut services,” Troutman said.

And that’s what advocates like Bethel worry about.

“When I was a social worker, working with seniors, property taxes were the straw that broke the camel’s back in people’s ability to stay at home,” Bethel said.

And that’s exactly what homeowners like David Marshall worry about.

“It’d make life difficult, and, in fact, I’d probably have to sell this house,” he said. “And that’s something I don’t want, because that’s my independence.”

Cover image Donkey Hotey, flickr creative commons

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