Health Care Challenge has moved to a new site

The Health Care Challenge has a new home as part of the redesign of the Observer's website. You can read editor Rick Thames' explanation of that change here.

The move means a new look and a new system for posting comments, which now matches the rest of the Observer's news.  I hope you'll keep reading and keep discussing. Please bookmark the new location: www.charlotteobserver.com/news/business/health-care/health-care-challenge-blog/

We've moved! (Image from charlestongrit.com)

Gallup: More in NC insured, but gains are small

North Carolina went from having just over 20 percent of its citizens uninsured in 2013 to 16 percent last year,  once the Affordable Care Act started offering subsidies to help people afford premiums, Gallup reported Tuesday.

But states that accepted federal money to expand Medicaid for the poorest adults saw bigger gains in coverage, according to the latest report from the Gallup-Healthways Well-Being Index,  which polls a random sampling of adults across the country. The national uninsured rate went from 17.3 percent to 13.8 percent, the lowest in the seven years of the well-being poll.

"Collectively, the uninsured rate in states that have chosen to expand Medicaid and set up their own state exchanges or partnerships in the health insurance marketplace declined significantly more last year than the rate in states that did not take these steps," Gallup reports. "The uninsured rate declined 4.8 points in the 21 states that implemented both of these measures, compared with a 2.7-point drop across the 29 states that have implemented only one or neither of these actions."

North and South Carolina, along with many Republican-led states, neither set up an insurance exchange nor expanded Medicaid. 

As Rose Hoban with N.C. Health News recently reported, bankers and business leaders have been receptive to the argument that expansion would bring financial benefits to the state,  though the state Chamber of Commerce has taken no position. And a coalition of health and anti-poverty advocates argue that expansion would save lives and create jobs. But state legislative leaders remain wary of the costs and complexities of expansion, and Gov. Pat McCrory has said he'll delay any plans to expand coverage until the U.S. Supreme Court rules on a challenge to the ACA.

Managed care groups push N.C. Medicaid reform

A coalition of insurance companies and managed care providers recently launched N.C. Medicaid Choice to lobby for change in the way the state administers the program.

"The Coalition supports legislation that shifts financial risk away from taxpayers by allowing traditional managed care plans, as well as plans offered by health care providers, to compete in the North Carolina Medicaid market," says an announcement posted Feb. 10.

Griffin

Aetna, Amerigroup, AmeriHealth Caritas, UnitedHealth Group and WellCare are the founding members. They've hired Taylor Griffin, a political consultant who ran for Congress in the 2014 GOP primary, as point person for the campaign. Griffin, an Appalachian State alum, worked for Sen. Jesse Helms and President George W. Bush before making his own bid for office (he lost to Walter Jones).

Republican leaders of the state House and Senate have talked about the need to reform Medicaid, which has a history of cost overruns, but haven't agreed on a strategy.  Griffin said Thursday his coalition supports the Medicaid Modernization bill,  which would let groups like the ones he represents compete with accountable care organizations run by doctors or hospital, over the Partnership for a Healthy North Carolina bill that turns Medicaid over to only the provider-led groups. 

Both involve the state paying a per-patient fee to groups that take the responsibility for providing care and controlling costs; they turn profit if they come in under budget or take the loss if they run over.  Both, says Griffin, provide incentives to push the kind of preventive care that not only cuts costs but improves lives -- for instance, prenatal care, timely screenings and healthy lifestyle changes. Allowing the established for-profit firms to compete will lead to bigger savings and a quicker roll-out, Griffin said.

A news analysis that ran in the Observer this week noted that in some Republican circles, "Medicaid reform" has become a euphemism for taking federal "Obamacare" money to expand coverage for low-income adults. Griffin said his group is taking no stand on Medicaid expansion in North Carolina. For them, reform is about fixing with the system that's in place, not making more people eligible.

ACA numbers: What's squishy, what's solid?

Early tallies of 2015 participation in the Affordable Care Act exchange are bound to raise follow-up questions,  not only among those who doubt anything President Obama says but those trying to sort out the nuances of a complex system.

The White House was eager to announce a preliminary estimate of 11.4 million sign-ups nationwide.  That includes totals from the 37 states that use the federal marketplace as well as  "preliminary analyses"  of data from state-run markets.  Federal officials say that number is 10 percent over the White House target, with numbers that jumped significantly in the final week.

White House graphic touting tally

As indicated by the  "preliminary" label,  that tally is bound to change.  Some states that run their own markets have granted extensions to the Feb. 15 deadline because of winter storms or system glitches.  Some who hit snarls in the federal exchange on the final weekend got an extra week to finish enrolling.

The tally includes people who selected plans but won't actually pay the premiums.  Kevin Counihan,  CEO of the federal marketplace,  predicts that about 87 percent of enrollments will translate to actual coverage.  That comes to about 9.9 million people.  Obamacare critic Avik Roy noted that 2014 ACA retention translated to 84 percent,  "fairly similar to (the rate) experienced by private insurers in the conventional ... insurance market."

The feds also released totals for the states using HealthCare.gov and major cities within those markets  (read that report here).  We don't yet have a breakdown of new plans vs. renewals for the states,  though Counihan said about 8.6 million of the 11.4 million nationwide,  or 75 percent,  were renewals.  Nor do we have a final count on how many got subsidies,  though a Feb. 9 report pegged North Carolina's total at 92 percent.

Katherine Restrepo,  health analyst for the John Locke Foundation,  notes that while that percentage may be accurate it can be misleading.  Those at the high end of eligibility (up to $95,400 for a family of four) get small tax credits that do little to lower costs, she says.

Roy contends that the White House tally is "deceptive" because it includes an unknown number of people who already had insurance and switched. It's true that the totals don't distinguish between those who had insurance and those who didn't,  though I'm not convinced that the White House and "friendly media outlets" have claimed otherwise.

Finally,  reader Bryan Griffith correctly called me out for not including any specifics in a recent article citing a surge of last-minute enrollments in Charlotte.  Here's what the latest report shows:  The Charlotte metro area got almost 17,000 sign-ups between Feb. 6 and Feb. 15,  or about 12 percent of the total enrollment logged during the 13-week enrollment period.

Unanimous vote to expand N.C. Medicaid? Well ...

Jeff Jackson,  a Democratic state senator representing Mecklenburg's District 37,  knows how to have fun with a snow day.

This morning he posted on Facebook that "Due to inclement weather,  I appear to be the only non-security person in the General Assembly this morning.  I feel like I should hurry up and pass Medicaid expansion.  Anything else while I've got the place to myself?

His constituents  --  or at least his Facebook friends -- got a kick out of that,  with more than 100 comments and 500 likes by 9:30 a.m.  He got a long list of requests,  from raising teacher pay to banning puppy mills and legalizing marijuana.

Around 8:30 a.m.,  Jackson started tallying his accomplishments:

Just came back from the Senate chamber. All votes were unanimous.

Medicaid = expanded. Teachers = paid. Film = jobs. What's next?

This is going to be like "Night at the Museum" except at the end we'll have a stronger middle class.

‪#‎JustOneLegislator‬ ‪#‎Snowday‬

Sen. Jeff Tarte, a Mecklenburg Republican, later posted that he and several GOP colleagues were there working as well.   "Classic example of Democrats 'misrepresenting the facts,' "  Tarte sniffed  before tipping his hand with an "LOL" and an invitation for Jackson to join him for dinner.

By that time the #JustOneLegislator winter fantasy had gone viral.  Mutual Facebook friend Laura Hehn had a suggestion  --  "Work together and make some positive changes!"  --  and even offered a couple of new hashtags: #JustTwoLegislators or #JustTheJeffs.

Losing health benefits? Study blames recession

If your employer provides health insurance,  you're probably paying more for less  --  and wondering who's to blame.  The Affordable Care Act has contributed to rising costs by mandating certain types of coverage,  allowing many adult children to stay on parents'  policies and levying a 2018 tax on high-cost  "Cadillac plans."

But the trend toward reducing benefits and dropping health insurance altogether was in full swing before the act kicked in this year, according to a recent analysis by the University of Minnesota’s State Health Access Data Assistance Center and the Robert Wood Johnson Foundation.

Before to the recession, the research shows that employer coverage was fairly stable.  Between 2004-05 and 2008-09,  for instance,  North and South Carolina,  like most of the country,  saw no significant change in the percent of employers offering health insurance.  But the rates dropped from 2008-09,  the start of the recession,  to 2012-13.  In North Carolina it went from 53 percent to 47 percent,  and in South Carolina from 54 percent to 47 percent.  Most of that decline has come from companies with fewer than 50 employees.

That's consistent with what I've heard.  For instance,  I wrote last fall about Charlotte's Blue Max Materials,  a small employer,  dropping health insurance in the face of rising costs.  Meanwhile,  the owner of Stafford Cutting Dies bumped up deductibles dramatically to cope with skyrocketing costs for a small-business policy.

“Most Americans still get health insurance through their jobs, but this has been declining for more than a decade,” said Katherine Hempstead, who directs coverage issues at the foundation. “It will be interesting to see how that trend evolves now that there are more opportunities for coverage through the individual market and Medicaid.”

The report includes detailed breakdowns for each state.

So you got insurance. Will it help?

As the 2015 push for health-insurance enrollment winds down, the next challenge grows ever clearer:  Insured people who can't afford medical care.

The New York Times Sunday Review carried an article titled  "Insured, but Not Covered."  Reporter Elisabeth Rosenthal explores trends in insurance and health care that are leaving people with insurance unable to find doctors or pay bills.

Her conclusion:  While the Affordable Care Act has brought coverage to roughly 10 million Americans and eliminated  "some of the more egregious practices of the American health insurance system that left patients bankrupt or losing homes to pay bills,"  the law has also adopted policies that "may in some ways be undermining its signature promise:  health care that is accessible and affordable for all."

A key culprit is the boom in high-deductible policies,  which allow employers and private buyers to reduce premiums by agreeing to much higher out-of-pocket costs.

For instance,  HealthSherpa recently sent along an analysis of  14,000 North Carolina health insurance purchases made on the company's web site,  which provides an alternative path for buying subsidized plans on the ACA exchange.  Those buyers had an average household income of about $20,400 and bought policies that averaged $70 a month for the buyer,  with the government kicking in an average of $381 a month.

But the average deductible per enrollee was $3,969 and the average out-of-pocket max was $5,745.  Can you imagine anyone making less than $21,000 a year being able to save $4,000 to $6,000 to cover those costs?  Reality is,  even paying a couple of hundred dollars may be daunting enough to discourage people from going to the doctor's office.

A recent report from The Commonwealth Fund showed that the number of people skipping care because of costs declined in 2014,   the first time since the question was added to the fund's health insurance survey in 2003.  But while the numbers fell significantly compared with 2013,  the year before the ACA took effect,  the report estimates that 66 million Americans,  or 36 percent of adults, still skipped an office visit,  test,  treatment or prescription because they couldn't afford it.

ontinue reading the main storyBut by endorsing and expanding the complex new policies promoted by the health care industry, the law may in some ways be undermining its signature promise: health care that is accessible and affordable for all.