Tag Archives: aca

North Carolina’s $51 Billion Gamble

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.

Measuring Success

There are many ways to measure success and/or failure, and it’s important to keep that in mind when you assess hot-button issues. For instance, this article in the Greensboro News & Record about Obamacare’s affect on insurance coverage in North Carolina:

In North Carolina, 16.7 percent of residents are now uninsured, compared with 19.6 percent before the onset of the ACA, according to a study conducted by the social network WalletHub.


North Carolina ranked 33 among states for its number of uninsured residents.

The Tar Heel state also ranked fourth among states with the most net new private insurance enrollees per capita.

WalletHub used data from the Kaiser Family Foundation, the Centers for Medicare & Medicaid Services, the U.S. Department of Health and Human Services and the Census Bureau to make its projections.

Those who supported Obamacare will likely tout this statistic as proof that Obamacare is working. On the other hand, those opposed to Obamacare can ask the question, “But at what cost?” That’s the crux of the issue: we can all probably agree that more people having health insurance is a good thing, but we’d probably have lots of heated debate over how much to pay for it, how to pay for it and how to structure the program. Does the phrase “socialized health care” ring any bells.

Quite frankly I think it’s far too early in the process to declare Obamacare a success or failure, but I’d say these numbers show a positive trend towards getting more people health insurance coverage. Long term who knows whether or not Obamacare will be a net success, but at a minimum we’ve seen thousands of North Carolinians moved off the roles of the uninsured and that’s a step in the right direction.


ACA Getting Real

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.


The Miracles and Limitations of Modern Health Care

My wife and I spent yesterday at Brenner Children's Hospital in Winston-Salem with our youngest son. Our son has been dealing with a condition called supraventricular tachycardia (SVT), which in layman's terms means his heart will sometimes beat really fast – like 200 beats-per-minute fast – for extended periods of time even if he's sitting still. He was in the hospital for a procedure called a cardiac ablation which, if successful, would prevent these episodes from happening in the future.

The way the ablation was explained to us is that the doctor would send catheters through major veins in the legs to our son's heart and, depending on where in the heart the problem was, either burn or freeze the part of the heart that was causing it to go into this abnormal rhythm. Our son would be put under general anesthesia for the procedure and it would likely take about four hours. They would provoke his heart into going "wonky" (that's our technical term for it), identify the problem area, treat it and then observe it for a period of time to make sure they got all of it. If they needed to they'd freeze or burn more spots until they had the problem area taken care of.

Here's the really amazing part: if all went as planned we'd have our son back home the same day and he'd be under orders to take it easy for four days, not lift anything heavy for about a week, and then he'd be back to normal. To us this was truly a miracle of modern medicine – our son would have a heart procedure as outpatient surgery!

Thankfully all went as planned and we had our son home last night. Truly amazing.

Unfortunately modern medicine also has its limitations. While we were in the waiting room during our son's surgery a doctor came out and met with a mother and grandmother waiting near us. It was very early in the morning and most of the folks in the waiting area were asleep, thus it was pretty quiet. We tried our best not to eavesdrop, but it was impossible not to hear pieces of what the doctor was telling the mother – that her child did indeed have some rare, malignant cancer. It was also impossible not to hear the mother's crying and her mother trying to console her. And quite frankly it was impossible not to break down ourselves once they left – I haven't cried in public since I was a child, and I'm not ashamed to say that I just couldn't hold it together. I can't imagine going through what that family is going through right now.

Right now our country is dealing with a lot of change in our health care system thanks in large part to the Affordable Care Act, aka Obamacare. There's (rightfully) a lot of discussion about how our health care system and the related health insurance industry work. The debate often focuses on cost and on whether or not we're moving towards a system of "socialized" medicine similar to Canada's or the UK's, and if we are, whether that will lead to a stall in medical advances that have led to every day "miracles" like what our family experienced.

Those are all worthy discussion points, but after yesterday all I could think was this: when it's your child in the operating room you really don't care how expensive the procedure is, you just want him to have whatever it takes to make him well. I would gladly live in a cardboard box in order not to have to hear what that poor mother next to us heard. Whatever we do I hope we continue to work towards making sure that fewer and fewer parents have to hear that their child doesn't have a miracle available to them at any price.