NC has chosen NOT to participate in expanded Medicaid coverage for its residents and has also opted OUT of running its own healthcare exchange, and its citizens will be the losers. It’s time for North Carolina to address the ABCs, the basics of what these choices mean for citizens.
Read about it in articles reported all over the place (search NC, Governor McCrory and Healthcare Exchanges, Medicaid Expansion to read about it).
It’s now left to the citizens of NC to demand reasonable performance from their government representatives. Cutting through any spin there are those things called facts. Affordable Care is the law of the land,even for NC.
The delays and stalling in the hopes that the Supreme Court would strike down the law failed, even for NC.
Affordable Care’s provisions for requiring the creation of health care exchanges IS THE LAW, even for NC. The only choice is whether STATES establish exchanges for themselves or whether STATES HAND OVER AUTHORITY TO THE FEDERAL GOVERNMENT.
There is NO CHOICE NOT TO HAVE A HEALTH CARE EXCHANGE. NC HAS CHOSEN FEDERAL OVER STATE.
Under section 1321(c) of the PPACA, Failure to Establish Exchange or Implement Requirements, the Federal government WILL establish a health exchange for NC residents.
Further, while the state of NC CAN CHOOSE TO TAKE BACK AUTHORITY AND CONTROL OVER ITS OWN EXCHANGE AT A FUTURE DATE, IT WILL NOT RECEIVE AS MUCH FEDERAL FUNDING TO DO SO.
READ the law, the Federal money for which states are eligible to use in establishing and running their healthcare exchanges which this year cover up to 95 percent of the costs, GO DOWN over time to 20 percent by the year 2020.
If NC decides it ever wants to be in charge of its own exchange at a later date it can but NC will bear more of the costs because it chose Federal control. (Refer to my post entitled, “States that Opt Out Should Face Fees: Opinion: Health Care Exchanges” for further details.)
MEDICAID Expansion is left up to the States under the Affordable Care Act. The expansion of Medicaid is covered by Federal dollars in its first years which would reduce the costs to the states.
NC has refused Medicaid expansion. NC will not increase the number of people covered by Medicaid for health insurance even though the Federal government would have paid the majority of costs for additional individuals covered under the expansion.
Therefore NC uninsured poor and indigent will likely increase or remain unchanged since NC unemployment is among the highest in the nation.
As of December 2012, NC ranked 47th in unemployment where 50th is the state with the most unemployment and one is the state with the least unemployment.(Look at website for Bureau of Labor statistics, bls.gov) NC has the FIFTH HIGHEST UNEMPLOYMENT IN THE NATION (because two states are ranked at 50) as of December 2012.
States that opt out of expansion of Medicaid, like NC, will not be protected from the REDUCTION IN FEDERAL payments for Disproportionate Share Hospital Payments provided for under the section 1203.
Section 1203 providing less federal money for Disproportionate Share Hospital Payments represents CURRENT FUNDING to hospitals for the treatment of uninsured and indigent patients, which will GO DOWN in 2014.
Disproportionate Share Hospital Payments Federal dollars will go down under section 1203 because the expanded Medicaid coverage was supposed to reduce the number of uninsured in states. But NC has chosen not to expand Medicaid even though it will still receive less money from the Federal government for Disproportionate Share Hospital Payments.
(See my post, “I’m Not the Other Guy…Medicaid Expansion and the Election).
In July of 2012, in “Becker’s Hospital Review: Business and Legal Issues for Health System Leadership,” in an article by Bob Spoerl, these same issues are discussed in a very readable way.
NC residents should demand answers regarding the choices of their public officials whose salary they pay.
