Category Archives: North Carolina

Billions Left on the Table

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North Carolina is one of the states that didn’t expand its Medicaid program after the passage Obamacare. According to this little item from the Wonkblog there are a BUNCH of states that are reconsidering their decisions to opt out:

Money talks: Medicaid expansion makes headway in Republican states. “Two things have led to a change of heart for some Republican politicians. Most of the 27 states that are already expanding the program have begun to reap billions in federal subsidies for insurers, hospitals and healthcare providers, putting politicians elsewhere under intense pressure to follow suit. As demonstrated by Pennsylvania’s deal with Washington, the Obama administration has also proved willing to accept tweaks that give the private sector a greater role in providing healthcare and place new responsibilities on beneficiaries. All of that has got as many as nine states talking to the administration about potential expansion terms.” David Morgan in Reuters.

According to the Reuters article referenced above, North Carolina is one of the states looking at what it can do:

Some states with Republican governors, such as Indiana, are negotiating with Washington for agreements that could pass political muster with conservatives back home. Others such as North Carolina, South Dakota and Wyoming are exploring options.

One of the reasons that North Carolina’s leaders said they didn’t want to opt for expansion is that they feared the Feds wouldn’t pick up the vast majority of the cost as they’d promised (I’m paraphrasing). Now that they’re seeing what kind of money they’re leaving on the table they seem to be second guessing their decision, but they’re likely going to slow-play their hand because things might change in November.

According to the Reuters article if the Democrats lose control of the Senate then the wave of Republican states reconsidering their Medicaid expansions might ebb. Here’s the irony for North Carolina Republicans, many of whom might benefit from Medicaid expansion: on this particular issue they might be better off if Dem. Senator Kay Hagan wins reelection. And if you think the only Republicans who might benefit are those who are eligible for Medicaid then you’re forgetting all the Republicans who work in the health care industry. Just look at the projections for Pennsylvania:

A study by the RAND Corp predicted a $3 billion economic boost and the creation of 35,000 jobs – big advantages for a state that has struggled for decades to make up for jobs lost from the decline of the coal and steel industries.

Unfortunately for the Democrats this kind of issue is far too complex to make an effective campaign tactic. After all, this is a country full of people who said things like “Keep the government’s hands off my Medicare” when Obamacare was being debated. You can’t possibly expect them to back a candidate out of enlightened self interest when they don’t even know what their self interest is.

North Carolina’s Literary Capital

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It seems that Hillsborough, NC is where the writers want to be:

At Christmastime each year, Michael Malone, a longtime TV writer, and Allan Gurganus, a bestselling novelist, put on a production of “A Christmas Carol” at an Episcopal church in Hillsborough, N.C. Mr. Gurganus plays Scrooge, and Mr. Malone plays nearly all the other characters. Jill McCorkle, another bestselling novelist, holds the record for perfect attendance.

In fact, more than two dozen of their fellow writers live in Hillsborough, population 6,087, where government meetings are held in the “town barn,” and the Wooden Nickel serves up fried green tomatoes. “Under the Tuscan Sun” author Frances Mayes lives in a 4,500-square-foot Federalist farm house here, and David Payne, author of the Southern saga “Back to Wando Passo,” lives in a renovated former clubhouse for local businessmen in the town’s historic district…

So what is it that draws writers to this small Southern town? Mr. Malone says it speaks to the nature of a writer’s work. Hillsborough allows writers to be at once isolated and close to friends and peers; while intensely focused on their next book or script, they still belong to a community that hosts barbecue festivals and a cemetery walking tour.

“Writers can get very isolated,” said Mr. Malone. “This is a real community. This is a real town, and it’s been a real town since the mid-18th century. That is the stuff of fiction.”

This tight-knit feel is attracting others to Hillsborough, said local Coldwell Banker real-estate agent Tom Sievert, driving up home prices. The median sales price in Hillsborough was $238,000 in July, up 25% from five years earlier, according to Triangle Multiple Listing Services.

“While we have this mecca for the authors, you’ll see them in front of Cup A Joe just having a cup of coffee. They’re just members of the community,” said Mr. Sievert. “I think that’s what drives people here. It’s a real friendly town.”

By the way, I highly recommend you read any of Malone’s books. They are great, entertaining reads and I particularly enjoyed Handling Sin, Time’s Witness and Uncivil Seasons.

Face of Poverty in the Piedmont Triad

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This article in the Greensboro News & Record has a lot of disheartening statistics:

In the past 10 years, the state (North Carolina) has gone from the 26th-highest poverty rate in the country to the 11th. One in 4 children are living in poverty.

At the same time, 1 in 5 people in the city of Greensboro live in poverty — that’s considered to be having an annual income of less than $24,000 for a family of four…

Of the Second Harvest Food Bank’s 400 partner networks, 90 are in the greater Greensboro area, including the Greensboro Urban Ministry. Second Harvest is one of a handful of regional food banks in the state.

In 2009, the group distributed 7.9 million pounds of food. This past year, the group distributed 25 million pounds of food.

You might be tired of reading about the food drive to benefit Second Harvest at my day job, but when given the state of affairs around here it would be immoral not to remind everyone that there is a readily available way to help.

North Carolina’s $51 Billion Gamble

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Brad DeLong has some thoughts about Obamacare and here in NC this one bites:

The willingness of state-level Republican politicians to hurt their own people–those eligible for the Medicaid expansion, those who would benefit from a little insurance counseling to figure out how to take advantage of subsidies, those hospitals who need the Medicaid expansion to balance their finances, those doctors who would ultimately receive the subsidy dollars–is, as John Gruber says, “awesome in its evilness”. The federal government has raised the money, and all the state has to do in order to get it spent is to say “yes”. Especially in contrast with the extraordinary efforts state-level politicians routinely go through in order to attract other spending into their state, whether a BMW plant or a Social Security processing center, this demonstrates an extraordinary contempt for a large tranche of their own citizens. And when I reflect that a good third of that tranche reliably pull the lever for the Republican Party year after year…

To that point, here’s some encouraging news about North Carolina’s non-participation in Medicaid expansion:

North Carolina’s decision not to expand Medicaid coverage as part of Obamacare will cost the state nearly $51 billion in federal funding and reimbursements by 2022, according to research funded by theRobert Wood Johnson Foundation…

It notes that North Carolina stands to lose $39.6 billion in federal funding between 2013 and 2022…

“States are literally leaving billions of dollars on the table that would support their hospitals and stimulate the rest of their economies,” says Kathy Hempstead of the Robert Wood Johnson Foundation.

The report notes that for every $1 a state invests in Medicaid, it will receive $13.41 in federal funds.

And here’s the real kicker:

The decision not to expand Medicaid coverage will leave 6.7 million U.S. residents uninsured in 2016. That includes 414,000 people in North Carolina.

Of course Obamacare isn’t perfect and Medicaid isn’t the end-all, be-all of health care insurance — DeLong himself says in his thoughts about Obamacare that “Where the Medicaid expansion has been allowed to take effect, it has taken effect. People are going to the doctor more, people are finding doctors to go to, and the only minus is one that we already knew: that Medicaid is not a terribly good way to spend our money in treating people with chronic conditions” — but it is still a better option than nothing and an improvement over the Emergency Room as primary care provider system that we’ve had.

What’s truly frightening to consider is where we’ll go from here. Without the funds our doctors and hospitals will be missing out on literally billions of dollars of reimbursement, almost 1/2 million citizens will be uninsured and will continue to use the emergency room as their primary caregiver, the hospitals will have to eat the cost and downward we spiral.

Hunger in Northwest North Carolina

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Through my organization’s annual food drive I’ve become very familiar with the work of Second Harvest Food Bank of NWNC. Unfortunately that familiarity is why the recently released results of a study on food insecurity provides little in the way of surprises, but does serve to help remind me of why we’re so passionate about our efforts on behalf of the organization. If, after reading the following numbers, you feel like helping out you can make a financial contribution at our food drive’s online donation page at  www.helpsecondharvest.com 

Here are just a few of the sobering statistics:

  • Nearly 300,000 different individuals turn to our network of more than 400 partner programs for food assistance annually – or 1 in every 6 people living in our region.
  • Despite Second Harvest Food Bank’s continuing success in sourcing more food for our partner agency network (in the past five years, distribution has more than tripled from 7.9 million pounds to more than 25 million pounds), 44 percent of programs report having less food than needed to meet the needs of those requesting assistance.
  • 32% of those who receive food assistance through our partner agency network are children under the age of 18. Because programs that serve only children were not eligible to be sampled for the Client Survey, for example our BackPack and Kids Cafe programs and summer meal sites, this percentage underestimates the actual number of children being reached by Second Harvest Food Bank.)
  • 10 percent of those who receive food assistance through our partner agency network are seniors age 65 or older. (30 percent are age 50 and older.)
  • 78 percent of those who seek food assistance from Second Harvest Food Bank’s network live in households at or below the poverty level.
  • 57 percent of households have monthly incomes of $1,000 or less.
  • Over the past year, 72 percent of households report choosing between paying for food and paying for medicine/medical care; 31 percent of these households are making this choice every month.
  • 73 percent of households report choosing between paying for food and paying
    for utilities.

    • 30 percent of these households are making the choice every month.
  • 72 percent of households report choosing between paying for food and paying
    for medicine/medical care.

    • 31 percent of these households are making the choice every month.
  • 72 percent of households report choosing between paying for food and paying
    for transportation.

    • 31 percent of these households are making the choice every month.
  • 64 percent of households report choosing between paying for food and paying
    for housing.

    • 24 percent of these households are making the choice every month.
  • 24 percent of households report choosing between paying for food and paying
    for education expenses.

    • 9 percent of these households are making the choice every month.

Remember, there’s an easy way to help at www.helpsecondharvest.com.

Meat-Like Coffee

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The Wall Street Journal had an article about a new coffee flavor wheel developed by a roaster in Durham, NC. Gotta say I like it;

Coffee Taster's Flavor Wheel

I’m gonna start using this around the office. Pretty soon people will hear me say things like, “At first it tastes leathery but there are definite tobacco undertones.”

https://counterculturecoffee.com/docs/CCC_Tasters_Wheel_85x11.pdf

Owning Up

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The University of North Carolina is a proud institution, but how its administration has handled the "Fake Classes Scandal" has brought shame on the institution. If nothing else they've provided a case study in how not to do governance and public relations. From the article about the treatment of Mary Willingham, the tutor who blew the whistle on this thing:

In January, CNN broadcast a national investigation entitled “Some College Athletes Play Like Adults, Read Like 5th-Graders.” Among its findings, CNN featured Willingham and her 183-athlete study. In the glare of the media spotlight, she got carried away, saying at one point: “I mean, we may as well just go over to Glenwood Elementary up the street and just let all the fourth graders in here.” Stephen Colbert amplified the furor when he satirized athlete education in a segment on his Comedy Central show. After playing a clip of Willingham’s quip about admitting fourth graders, the comedian asked: “Why? How fast can they run the 40? Can they really take a hit?”

Many in Chapel Hill took offense. Tar Heel basketball coach Roy Williams suggested at a press conference that Willingham had impugned the moral character of his players. “Every one of the kids that we’ve recruited in 10 years you’d take home and let guard your grandchildren,” he said. Smith, the French history scholar, observes that “getting criticized by the basketball coach in Chapel Hill is a scary thing.” The wave of hostile e-mail Willingham has received included several death threats.

In this volatile atmosphere, Folt convened her faculty on Jan. 17 to hear what amounted to an indictment of Willingham led by Dean. The defendant was tried in absentia for defaming the university. Pointing to slides projected on a large screen, Dean, a scholar of organizational behavior, accused Willingham of making slanderous statements about the academic abilities of Carolina football and basketball players. Her assessments “are virtually meaningless and grossly unfair to our students and the university that admitted them,” he said. “Using this data set to say that our students can’t read is a travesty and unworthy of this university.” The verdict, recorded on videotape, was swift: The assembled scholars erupted in applause.

“In 25 years of faculty meetings, I’ve never seen anything like it,” Smith said later. “It was a public conviction and an intellectual execution.”

At Dean’s order, Willingham turned over her data on the 183 athletes to him. He declared that the diagnostic test she used, the Scholastic Abilities Test for Adults (SATA), assesses vocabulary and isn’t recommended for judging literacy levels. She further muddled her results, he added, by miscalculating grade-equivalent levels.

After Dean’s presentation elicited applause, Frank Baumgartner, a political science professor, got to his feet. He mused aloud about the university’s focusing on Willingham as a form of coverup. “President Nixon went down for denial,” he told his colleagues. In an interview later, he elaborated: “What I heard was stonewalling,” he said. “The university is trying to distract us by going after Mary Willingham when there are much bigger issues here about sports and academics, and they’re not unique to North Carolina.”

There's much more in the article you should read for the proper context, and towards the end of it there is mention that it does appear the university administration is finally taking appropriate steps to address the situation, but this account seems to make it clear that the University's powers-that-be finally woke up and decided that shooting the messenger wasn't the best idea. Of course they'd still like to see the messenger dead on the field, but that's just the cost of doing battle in the intercollegiate athletics war isn't it?

Lovefeast

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From "A Prayer for North Carolina" comes an excerpt of a prayer Fred Bahnson imagines saying forty years from now:

The boy takes his first bite of bread. It’s sweet and moist and has a strange flavor. “Mace,” his grandfather says. The boy is secretly thrilled that he gets to eat and drink real food in church. Yellow beeswax candles with red crepe paper are handed down the pew. The room goes dark. A lone candle is lit, then another, and another, until the light reaches the boy. His lit candle is one of hundreds, and as he holds up his light and munches his bread and sips the sweet, weak coffee, he feels there is no place else he would rather be than here.

The memory of this meal — its peace, its fullness, the knowledge of God’s presence — will follow the boy for the rest of his life. When the boy becomes a man, he will attend a North Carolina seminary, but instead of becoming a preacher he will travel to Mexico to work with Mayan coffee farmers, sharing simple meals of tortillas and sweet, weak coffee. While there he will discern a call from You, perhaps the clearest call you have given him to that point in his life. A call to feed people. The boy-man will go to Chatham County to a small permaculture farm, where he will begin to learn the agrarian arts. He will meet his bride, and together they will help a church start a communal food garden for the hungry — an acre of vegetables and fruit in northern Orange County — and for the next four years the man will lean fully into his calling to feed people.

NC DHHS’ Software Armageddon

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North Carolina's Department of Health and Human Services (DHHS) is responsible for the launch of two new software systems this year that have experienced significant problems, and things likely will get worse before they get better.

The first problem you've probably heard about: DHHS' rollout of the NC FAST system to handle food benefits, aka food stamps, has been problematic around the state and has led to local agencies working with local food banks to make sure people have access to food until their benefit situation can be straightened out. The problem is that NC FAST is supposed to also handle Medicaid claims as of October 1 and it seems highly unlikely it will be able to do so particularly in light of DHHS' other, less well known software snafu.

Earlier this year DHHS rolled out NCTracks which is a new system to process professional Medicaid claims otherwise known as claims from doctors, medical groups, hospitals and other health care providers. That system is so screwed up that some independent practices have already gone out of business. From an article at charlotteobserver.com:

Karimi, 28, had worked for his parents for the past five years. Their company, Right at Home, had provided home health and personal care to the elderly and people with disabilities in Granite Falls. Karimi handled the billing.

But now Karimi is out of a job and his parents are out of business after a decade. The reason? They weren’t being paid for the Medicaid-reimbursed services they delivered in July and August after the state rolled out its new Medicaid payment system, known as NCTracks…

And it’s not just small providers who are having trouble.

In an interview last week, WakeMed CEO Bill Atkinson said his institution was down $1.5 million since July 1 because of NCTracks. He worried that his billers would have to re-submit all of those claims by hand.

It would be easy to blame the current administration for all this  but the reality is that these systems were contracted long before Gov. McCrory was elected and his folks now have the unenviable task of implementing very complex systems that affect a lot of people. If the response to client issues has been as slow or nonexistent as is being claimed by folks interviewed for these stories then the new administration, and by administration I mean Gov. McCrory's appointees at DHHS, needs to take responsibility and do whatever is necessary to get people the help they need. If they don't we'll be looking at a lot of lost jobs in the health care industry, and in particular we could see some small medical practices under severe stress or maybe even folding.
Glitches happen and anyone who's been through a systems upgrade knows they rarely if ever go as planned, but how an organization responds to those glitches is where the "men are separated from the boys" and right now the DHHS folks look like a bunch of little boys at recess the day after Halloween trying to burn off all the sugar they had the night before.