Category Archives: North Carolina

BCBSNC Affordable Care Plan Rates

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Blue Cross Blue Shield of NC released their premium rates for their various Affordable Care Act plans and while the numbers are very general, which makes it impossible to compare directly to your current plan if you have one, and there's also no way of knowing which subsidies you might qualify for until you can plug your income numbers into the formula. Those subsidies will be significant for some people:

Consumers can purchase the same BCBSNC ACA health plans, and access subsidies, from the Exchange or directly from BCBSNC. BCBSNC’s buy online tool facilitates the transaction for those who qualify for a federal subsidy (consumers purchasing their own coverage with income levels between 100 percent and 400 percent of Federal Poverty Level2). The subsidy impact will be significant for some. For example, a person earning 100 percent of FPL could pay $19.15 per month for a Silver plan.

And then there's this tidbit:

ACA health plans generally offer richer benefits than plans many BCBSNC customers choose today, according to the insurer. In addition to requiring richer benefits, the ACA eliminates the use of gender or health status in setting premiums.

At work we have BCBSNC's Blue Options coverage. It's age-banded so every five years the rates go up pretty significantly – for instance when I turned 45 I cost a lot more to insure than when I was 44 – but when I compare my individual rate with the chart of sample plans on the BCBSNC announcement page I see that my premium is more than a 40 year old's platinum plan, but my coverage (70% of cost) is about the same as the silver plan. This leads me to believe that, all things being equal, my individual coverage might be cheaper under ACA than with Blue Options. 

Another factor working against us at the office is that we have a very small group of three families so we have experienced some very steep increases over the last few years as we each breach those five-year age bands. We've been lucky in that our employer has covered our individual coverage premiums – family/dependent coverage is 100% out of pocket – but the only way to continue that each year has been by increasing co-pays and deductibles, and reducing the percentage of expenses covered from 80% to 70%. If the premiums continue to rise at the 10-30% annual rate we've been seeing the last few years then we're likely going to have to start paying a percentage of premiums out of pocket as well.  Combine those increased costs with access to potential subsidies and all of the sudden those ACA rates look more and more appealing, especially if our employer agrees to raises in lieu of health coverage. 

My prediction? Lots of small employers will decide to forego the headaches of administering a health plan and save some money in the process by prodding their folks to utilize the marketplace. That, of course, is exactly what the marketplace administrators want.

ACA Getting Real

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Despite the noise being made from the lunatic fringe of the Republican party about shutting down the government in an effort to force the defunding of the Affordable Care Act (ACA), the reality we're all facing is that the implementation of the ACA is set to begin in earnest over the next couple of months. For those of us who aren't intimately familiar with the effects that ACA will have on our lives there are now a few resources we can access to try and understand where this law is going to take us. Those resources include:

  • The Nevada Department of Insurance's site dedicated to explaining the ACA and allowing folks to get quotes for the various plans available through the state's exchange/marketplace. Obviously the quotes won't apply to non-residents of Nevada, but the general information is useful to non-residents and the pricing should be someone relevant to other states, especially when it comes to subsidies for lower income individuals and families.
  • The Triad Business Journal has an article about Blue Cross Blue Shield of North Carolina's announcement of its rates this coming Thursday and what we North Carolinians will likely be looking at come the October 1 deadline for insurers to make their rates public.
  • The US Census' site that shows how many uninsured there are in NC by demographics, which is a good indicator of how many people will be eligible for coverage and subsidies under the ACA.

While it's nearly impossible for anyone to predict exactly what's going to happen with the implementation of the ACA, it's becoming increasingly clear that major changes in the health care marketplace are afoot. One thing I personally hope to see is that the NC market for health insurance grows more competitive. We've had what is for all intents and purposes a duopoly in this state for years and it would be great to have more viable, competitive insurers to choose from.

 

A Revival of Compassion, Part II

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Earlier this week I wrote a post that was prompted by Rev. Mike Aiken's letter to the editor that calls into question our elected leaders' compassion for the poor. In that letter he wrote:

Congress continues to debate proposed massive cuts to the food stamp program. As a result of a computer glitch at the N.C. Department of Health and Human Services, the demand for emergency food bags more than doubled overnight. With the decision not to extend unemployment benefits, 12,000 Triad families are facing homelessness. In July, Urban Ministry assisted many of these families with more than $52,000 in direct assistance. The decision of our legislature not to accept federal Medicaid funding that would cover an additional 500,000 North Carolina medically indigent residents was a major factor in the decision to close the HealthServe Medical Clinic at the end of August.

Rev. Aiken is the Executive Director of Greensboro Urban Ministry and thus has an up close and personal view of the effects these cuts in government programs are having. His organization is being stretched thin trying to keep up with the increased need, and his isn't the only one. From an opinion piece in yesterday's Winston-Salem Journal written by David Heinen, director of public policy and advocacy for the NC Center for Nonprofits, and Holly Welch Stubbing, senior vice president and in-house counsel for Foundation for the Carolinas:

Sequestration spending cuts may cause members of Congress to assume nonprofits in our communities will always be able to fill the gaps in providing basic safety net programs. The reality, however, is that the ongoing effects of the recession have placed such a strain on nonprofits that many lack the capacity to take on this added responsibility.

The workload of many nonprofits has increased as the number of North Carolinians living in poverty has jumped to nearly 18 percent. In 2011, 93 percent of North Carolina nonprofits experienced an increased need for services, and 58 percent were unable to meet these needs. Two out of every five nonprofits operated at a deficit last year, and one-third had to cut programs or services.

The main point of Heinen and Stubbing's piece was to stress the importance of state and federal governments fully preserving the deduction for charitable contributions as they work on tax reform. They pointed out the stress being felt by nonprofits is extreme due to the increased demand for their services prompted by a still rough employment situation and a reduction in government aid, and they argued that if states and the federal government were to eliminate or reduce deductions for charitable contributions it would truly put the nonprofits in an even more tenuous position. 

Quite frankly we as a society are currently in the position of having to choose between negative options when it comes to the poor and needy: do we help them via government programs, nonprofit programs or some combination of the two? These are negative options because they are reactionary in nature and do nothing to address the root causes of poverty and hunger. Until we address those root issues – jobs, education, out-of-control health care expenses, etc. – our government/non-profit programs will continue to be needed by too many people instead of serving their proper role as a safety net of last resort for the very unfortunate who have hit rough times due to unforeseen circumstances.  Here's the crucial part though: until we do address and resolve those root problems then we must find away to keep people off the streets and my fear is that the programs we have in place won't be able to do it.

When Glitches Are More Than Inconvenient

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Yes! Weekly is reporting on problems with a rollout of North Carolina Department of Health and Human Service's NC FAST program:

North Carolina Families Accessing Services Through Technology, which is being implemented across all 100 counties of North Carolina, is designed to integrate various social services, including food stamps, Medicaid and WorkFirst, creating a kind of "one-stop shop" for clients seeking assistance. The Forsyth County Department of Social Services calls it a "no wrong door" approach.

Beginning in early July complaints began to crop up in Forsyth County about food stamp benefits being held up for current clients applying for reactivation. A number of clients said their benefits had been delayed for months on end, and food pantries and agencies that provide free meals reported an increase in demand that was partially attributable to disruption in food stamp benefits. Those complaints were a reprise of similar concerns expressed in neighboring Guilford County where the program was piloted.

Many of us have lived through the inconvenience of a software upgrade that didn't go as smoothly as planned, or improved our lives as much as the upgrader promised, but I seriously doubt many of us have lived through such dire consequenses as the result of a systems upgrade. Combine this with the recently constrained unemployment benefits and it's apparent that we all need to be prepared to step up our game to help our local food pantries meet the spike in need in the immediate future. 

I’m Just a (North Carolina) Bill

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Many of us of a certain age learned most of what we know about government and grammar from Schoolhouse Rock. Unfortunately there isn't a Schoolhouse Rock piece about the process the North Carolina legislature goes through to draft a new law, but thanks to a guest piece in the Greensboro News & Record's Sunday opinion section we do have a fairly understandable overview provided by Louis Panzer, the executive director of North Carolina 811:

For those of you unfamiliar with the process, here is the flow in a nutshell: A bill is drafted by a team of research analysts and then introduced in either the House or the Senate. This requires sponsors who carry the language through the chambers, explaining the nuances and seeking votes to approve and move to the next level.

Each bill requires three readings in the chamber it originated in. During this process, a bill may be sent to a committee. Once the bill leaves the original chamber, it “crosses over” to the other for another round of three readings and more potential committee attention. Each time this happens, there is an opportunity for amendments. In some cases, the amendments adopted by one chamber are rejected by the original chamber. Then more modifications might have to be made. When a bill finally receives the governor’s signature, it becomes law.

Sounds simple right? Well, let's just say that the process truly resembles the proverbial sausage making and is rarely as simple as it sounds.
As for law making at the federal level, I'll leave the explanation to our friends at Schoolhouse Rocks:
*Note: This is a crosspost of an item I wrote for work*

It’s a Start

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In the past I've written extensively about how frustrating our health care and health insurance systems are in the good ol' US of A.  As I see it one of the biggest obstacles to true health care reform in this country is the lack of transparency in the system, or in laymen's terms, the fact that you generally have no idea how bad you're screwed until well after you've received whatever treatment or service for which you visited the doctor.

That's why I was very interested in this piece at the Triad Business Journal's blog:

Passed last week in the waning days of this year's legislative session, the "Health Care Cost Reduction and Transparency Act of 2013" (House Bill 834) will create an online database of what hospitals are paid, on average, for the 100 treatments they perform most frequently. They'll also be reporting their costs for the 20 most common surgical procedures and 20 most common imaging procedures.

Take a case of pneumonia. N.C. consumers will now be able to go online and compare a variety of prices for that treatment. The database will tell them what Medicare pays for the treatment of pneumonia, what Medicaid pays and the average of what the five largest insurers in the state would pay the hospital.

Additionally, the database will offer up what the charge will be for a person with no insurance, and what the average price that the uninsured are able to negotiate with the hospital to pay.

That's a lot more info than is now available to N.C. consumers, though a clearer picture of what health care costs are in the state is still emerging.

This is what NC's attorney general had to say:

N.C. Attorney General Roy Cooper, who had advocated for several of the provisions included in the final transparency law,praised its passage.

“We recommend that consumers shop around for a good deal, but our health care system doesn’t make that easy to do,” Cooper said. “Giving consumers straightforward information on what medical services cost and what they owe will help them make better decisions about their health care.”

He's got that right, especially when you're talking about preventive or non-urgent care. Obviously if you're in an emergency situation the last thing you're going to think about is whether or not the hospital nearest to you is the cheapest, but when a consumer has time to think having accurate information is the most valuable tool at his disposal. 

What I hope we see in the very near future is an app on our phones that will be linked to a database of ALL medical procedures from all health systems. And while I'm dreaming I'd love to see our state have more viable health insurance options than the duopoly we currently "enjoy" in North Carolina.

Interesting Times

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It sometimes takes living in interesting times to make you realize that boring is vastly underrated. The Great Housing Bubble followed by the Great Recession have caused many of us to live through some interesting times, and the reaction by our elected leaders to the fallout of those interesting times has led to even more interesting times.

Here in North Carolina we're starting to get national attention for the way our state leaders are reacting to the aftermath of the recession. The state is a perfect storm of economic hardship and political sea change that makes it a perfect political story on a national level. Unfortunately at the root of those stories is the suffering of real people, some of whom are our friends and neighbors, and the ideological response of the newly dominant political party to the economic reality that those people represent.

Lots of ink has been spilled about new conservative policies that have been put in place this legislative term and the Moral Monday protests that were prompted by those policies.  Quite frankly it's a complicated issue, and in defense of both sides of the arguments it should be noted that they almost certainly feel their way is the best way to address the whole of the problem, but from the point of view of those of us who are neighbors and friends of the very folks who are directly affected now by these policies it's hard to swallow the big picture economic arguments while they suffer.

Probably the best thing I've read about this issue is something a friend linked to on Facebook that addresses the Moral Monday protesters and why their protests are righteous even if you disagree with some of their specific remedies/arguments:

“For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me…The King will reply, ‘Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me.’” (Matthew 25:35-36, 40)

God is far bigger than a single political party. There are many paths and policies for addressing poverty, reforming our broken immigration system, responding to climate change, and healing the racial divides that continue in our society. But what we cannot accept, nor allow, is for our own leaders to willfully exacerbate our problems and directly harm people who are already suffering — to sacrifice the common good to their own ideological agendas. In such moments and times, people of faith must speak out — not for the sake of politics, but because the beauty and simplicity of the gospel demands it. (Emphasis mine)

For those of us whose faith compels us to do everything we can to help the unemployed, hungry, homeless, etc. we cannot ignore the long-term economic policies that can lead to those states. We must acknowledge that there are many different ways to address the underlying sociological and economic issues that are the root of those problems. We must be ready to admit that perhaps some conservative ideals might be the way to go, or that perhaps some government-led initiatives truly are the only hammer that will work on that nail.  But, and this the crux of the argument for me, it doesn't matter which path is best if people get seriously hurt during the journey. It is our moral imperative to make sure that the least of us is cared for, and if our journey has to take a little longer or follow a crooked path, i.e. involves ideological comprises in order for us to be able to help carry those who need help, then so be it. 

Young Adults and Obamacare

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We've all heard our fill about Obamacare, but because it is so complex most of us don't have a clue what's going to happen as its implementation kicks into gear next year. That's beginning to change as all kinds of research is being done and reports on the results of that research starts to hit the news.

Earlier this week we saw plenty of coverage of the Rand Corporation's analysis of the 14 states that have opted not to implement the Medicaid expansions called for in Obamacare, and the projections aren't good for those states which include North Carolina. Now comes this fascinating interview with the executive director of Young Invincibles, a group that studies young adults' role in health reform. The interview is about how young adults view health insurance and the likelihood that they will opt in to Obamacare, which everyone seems to agree is a critical factor in the success of the program. Here are the most interesting tidbits:

About 19 million young adults 18 to 34 lack health insurance. Our polling shows that less than 5 percent of young people choose not to have it. The number one reason they don’t have it is the cost. Most young people don’t qualify for Medicaid right now even if they have very low incomes because most states just don’t give childless adults Medicaid. That’s one of the biggest changes under Obamacare. If every state expanded Medicaid, about 8 million would qualify for Medicaid. Another 9 million would qualify for subsidies because they make less than 400 percent of poverty.

So then 17 of the 19 million uninsured young people are, in theory, eligible for either subsidies or Medicaid under Obamacare?

That’s right. It’s a pretty phenomenal percentage. So if we do our jobs right, young people will be one of the biggest winners in the health-care law…

 But the cost does matter. So is Obamacare actually going to make insurance affordable for this group? Or will it make insurance more expensive for young, healthy people by making it easier for sicker, older people to buy insurance without getting discriminated against? 

The first important point is the huge percentage of unemployed young people who get access to either subsidies or Medicaid. So you saw in California that many young people will end up having insurance options that cost them less than $100 or less than $50 simply because their income is low enough to qualify for subsidies. For someone making $20,000 a year, they’re going to have to pay $40 a month for health insurance. That’s a very good deal. And in a state like California, there are also millions of young people who qualify for Medicaid.

Now we’ve identified a population between 300 percent and 400 percent of the federal poverty level that’s going to have more problems. The subsidies aren’t that rich for them, and so whether to buy is a tougher question. They’ll have financial strain. They have financial strain now. That’s why they’re uninsured. If you’re just getting by, then $200 a month can be a lot. That’s where education can be key. It can still make good financial sense to be covered because there are real risks. But I think, in general, it will be a good enough deal to sign up. We saw that in Massachusetts where youth uninsurance dropped in half in the first year…

So given all the issues of implementation and the political opposition to the law and the difficulties in various states and the early information about premiums, where do you think this will end up in 2014 and 2015? Do you think young people will sign up or stay away?

I’m pretty hopeful, in part because the experience in Massachusetts showed this model can work. But it will play out differently in different states. A state like California is following the playbook. They’ll do a big promotional campaign. They’re investing in on-the-ground outreach and education. They’re expanding Medicaid so really low-income folks will qualify for health insurance. So I could see it being a huge success in a state like that. But not every state will do that. An important point for young people is that some of the states with the highest rates of youth uninsurance are in the south and some of those states aren’t expanding Medicaid or building their own exchanges. My fear is what happens in those states. So I could see some states coming out and looking much better than other states.

As a father of three children a couple of years away from entering the working world and as a resident of North Carolina, one of those southern states not "following the playbook", that last paragraph truly worries me.

The Unfortunate 14

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North Carolina is one of 14 states that has opted out of the new Medicaid funds linked to Obamacare. What does that mean? According to a new Rand Corporation study it means those states are sailing into a stiff healthcare wind:

The study, by the Rand corporation, looks at the 14 states that have said they will opt out of the new Medicaid funds. It finds that the result will be they get $8.4 billion less in federal funding, have to spend an extra $1 billion in uncompensated care, and end up with about 3.6 million fewer insured residents.

So then, the math works out like this: States rejecting the expansion will spend much more, get much, much less, and leave millions of their residents uninsured. That’s a lot of self-inflicted pain to make a political point.

It’s a truism of health-care politics that the uninsured are impossible to organize. But Obamacare creates an extraordinarily unusual situation. The Affordable Care Act will implemented in states that reject Medicaid. There will be huge mobilization efforts in those states, too, as well as lots of press coverage of the new law. The campaign to tell people making between 133 and 400 percent of poverty that they can get some help buying insurance will catch quite a few people making less than that in its net. And then those people will be told that they would get health insurance entirely for free but for an act of their governor and/or state legislature.

North Carolina is already seeing political activism spearheaded by the state's NAACP chapter against policies of the Republican legislature. Just yesterday the NAACP's ongoing "Moral Monday" campaign led to more than 150 arrests at the state capitol. Quite frankly that action is easy for a lot of people to dismiss as just more of the same from a group trying to justify its existence (when doesn't the NAACP protest?), but if people who normally sit on the sidelines are suddenly spurred to action because their government denied them the opportunity for cheaper (or free!) health coverage then things could get very interesting for the next election cycle here in the Tarheel state.

(h/t to Fec for the link to the story).

This is How You Do It

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First a disclaimer: the following is my personal opinion and in no way reflects an official stance of my employer.

Last week I was in Raleigh meeting with legislators about issues related to my day job. The North Carolina legislature is a pretty intense place right now and the legislators, who are always busy during the session, were busier than normal for a variety of reasons. As a result we were only able to meet in person with about half of the legislators from the Triad and luckily for me one of those people was Rep. Ed Hanes,  a freshman Democrat from Forsyth County. We talked about our issues and just before we said our goodbyes the subject of education came up. That's when it really got interesting.

One of the folks in my group has a child getting ready to enter the public school system. After listening to Rep. Hanes speak about public education she asked his advice about how to approach it. Rep. Hanes took a couple of minutes to talk to her about it, and then he started talking about co-sponsoring an education-related bill with a Republican. Well, you could have knocked me over with a feather. A Democrat and Republican co-sponsoring a piece of substantive legislation in this day and age? Whoa!

Not surprisingly Rep. Hanes said he was catching some heat over the bill, and given that it's about allowing vouchers to be used with private schools you can bet he's getting heat for multiple reasons: crossing party lines and "sabotaging public education" being the two most obvious. Sure enough the bill was hot enough that it became the subject of a front page article in the 5/30/13 Winston-Salem Journal:

House Bill 944, known as the private school voucher bill, passed the House education committee Tuesday by a narrow, 27-21 margin. It moves next to the House appropriations committee — likely next week, said co-sponsor Rep. Ed Hanes, D-Forsyth.

Hanes went against party lines in endorsing the bill, which has received sharp criticism from Democrats and opponents who fear the bill could damage public education. Hanes said that while the plan is not perfect, the latest version of the bill that passed the education committee Tuesday is a marked improvement from the bill’s original iteration.

“When you’re 27 seats down, you have to use the tools you have,” Hanes said. “Vouchers are not the answer. Charter schools are not the answer. Even public schools as we have them currently constituted are not the answer to educating economic disadvantaged students.

You don't have to like the bill in order to like what Rep. Hanes is doing. It's old-school legislating in that he's showing the gumption to take a potentially unpopular stance to do what he thinks is best for his constituents. The man is showing some real backbone because in a very partisan world he's willing to cross party lines and at the same time he's taking on one of the most infuential bodies in NC politics-the public education industrial complex. 

Wouldn't it be refreshing to see more action like this in Raleigh and Washington?