Blog Roll

In addition to the wordpress blogs I follow, I made sure to keep with the following sites which provided more focused reports on health care, most specifically relating to North Carolina’s health care:

http://www.northcarolinahealthnews.org/nc-health-beats/

http://www.bcbsnc.com/content/healthcarereform/spotlights.htm?id=insurance

http://www.publichealthnewswire.org/

http://www.dailytarheel.com/section/state

Reflection

I knew little about North Carolina’s health care issues before doing this blog, but I thought I was informed on Obamacare and its main aspects. I found out, through this blog, that I wasn’t as informed as I had thought. I knew that I was opposed to Obamacare because the federal government shouldn’t be able to force U.S. citizens into buying health insurance and because it would raise prices for consumers, and I maintained these views, but I didn’t know about many of Obamacare’s other aspects, such as insurance companies not being allowed to refuse coverage to an individual with a pre-existing condition or that businesses would have to provide health insurance for their full-time employees. This project forced me to delve deeper into Obamacare and all of its aspects and effects.

My research led me to develop a more moderate view of the Affordable Care Act, as it as many good aspects such as providing subsidies and other types of aid for individuals and families who don’t make a lot of money and ensuring that people with pre-existing conditions won’t be turned away by insurers. However, some of my views were only reinforced. The additional costs to health care the Affordable Care Act will present, for example, is undeniable. I was able to understand North Carolina’s decision not to run the exchange, but I saw flaws in these plans as not having a state-run exchange probably led to the lack of competition and high rates.

Blog writing has forced me to keep up with my issue and further investigate the different aspects of it. This has taught me to do the same with other issues, especially those I am passionate about. I have grown from a more passive thinker to actually wanting to discover more on topics I hear about and may already think I know about. I have become more active in turning my opinions into educated stands. I now better understand the reasoning of each side and so can better defend my position. I will not base my own ideals on others’ opinions but search for the facts behind issues and form my own stand from these. Passion about a topic is important, but that passion should be based on research and facts and understanding all sides rather than just emotional reactions not based on legitimate information.

Class-links

Health care hasn’t been the only issue recently brought up by the North Carolina General Assembly. Some of my classmates investigated other issues, and here are some that are worth checking out.

http://estoniansugar.wordpress.com/      The General Assembly repealed the Racial Justice Act which allowed death row inmates to appeal their sentencing on the grounds that they had been racially discriminated against. My classmate really did her research and offered an interesting perspective on the act’s repeal. She really delves into the justice of the act and its repeal while analyzing the claims that the act was reducing the efficiency of the judicial system. She focused on the subjectivity surrounding the act and used this as a basis for her claim that the act was rightfully repealed. There is great detail in her blog and she explains the Racial Justice Act and its effects on the judicial system to great length. I found it very interesting and hope you will too.

http://105education.wordpress.com/     This blog explored aspects of North Carolina’s education system introduced by the General Assembly like merit pay, school vouchers, and budget cuts. She offered a very interesting perspective as her mother is a public school teacher which I think provided some more direct analysis of the effects of these changes to the education system. She provides interesting analyses of North Carolina teachers’ pay and the support of private schools through vouchers. I enjoyed keeping up with her blog which included personal experiences of North Carolina public education from the students’ and teachers’ perspectives.

http://votingid.wordpress.com/      I followed this blog and was very impressed by his knowledge of the voter ID laws and the other voting restrictions the General Assembly passed. He explained the reasoning provided for the law, to avoid voter fraud, but pointed out the problems with this claim as voter fraud has not been a major issue in North Carolina. He describes the effect this law is having on the rest of the country as other states are beginning to pass similar voter ID laws. I found out a lot about the voter ID laws from this blog.

Links

I came across many helpful resources in my research of the North Carolina General Assembly’s decision not to run the state’s health insurance exchange program. If you are interested in learning more about Obamacare and its effects on North Carolina, I would suggest exploring the following links:

http://obamacarefacts.com/obamacare-myths.php    This website has many different pages on helpful topics if you want to learn more about Obamacare. This specific page outlines some of the common myths about Obamacare and really helps to explain what the Affordable Care Act actually is and does.

http://www.citizen-times.com/viewart/20130926/NEWS/309260032/Costs-NC-health-plans-higher-than-US-norm    This website details the prices North Carolina will see on the state’s federally-run exchange. It also explains the little competition seen in the exchange and compares North Carolina’s exchange to the rest of the country.

http://www.bcbsnc.com/content/healthcarereform/spotlights.htm?id=insurance     This is Blue Cross and Blue Shield of North Carolina’s website with links to documents detailing the changes the Affordable Care Act will make to health care. The ACA Taxes and Fees link is especially helpful in explaining why rates will increase and showing the taxes and fees the ACA will put on BCBS.

http://www.northcarolinahealthnews.org/2013/09/24/north-carolinians-continue-to-lag-behind-nation-on-insurance/    This site tells of the history of health insurance in North Carolina. It explains North Carolina’s economic struggles and how health insurance has proven costly in the state.

http://www.newsobserver.com/2013/10/01/3245945/nc-residents-praise-pan-new-federal.html       Providing information on the exchanges after their opening amidst the government shutdown. This site offers the stories of real people and the real costs in North Carolina’s exchange.

Implications

If the debate surrounding Obamacare in North Carolina persists without resolution, we may see more businesses trying to cut their costs by moving employees to part-time or raising their prices, and health insurance prices along with taxes will continue to rise. On a national scale, the tension already had a hand in the government shutdown in which compromise over the budget could not be reached as Republicans attempted to eliminate aspects of the ACA they didn’t approve of. In North Carolina, the exchange is federally run, which could have dissuaded companies from joining and resulted in little competition and high prices. If this is not resolved, North Carolinians will face increasing health insurance prices as the companies raise rates to offset the added taxes and fees the ACA calls for. The prices will not diminish over time as the ACA originally claimed as the taxes for companies will increase. Obamacare will end up raising health care spending, both for the government and individual families. Businesses will face similar issues as Obamacare requires companies of a certain size to provide insurance for their full-time employees. Large and small businesses will be affected by the taxes and fees the ACA will impose on them, but each company will have to decide which direction to take to minimize costs, and many in North Carolina are choosing to raise prices in order to either pay to insure their workers or pay the fine for each employee not insured. Penalties for not having insurance or not providing insurance to workers, taxes and fees on insurance companies, and taxes on “Cadillac” health plans will increase through the years. If North Carolina does not have a hand in the exchange, there may not be any new competition and so rates will increase.

Theory Post

The opposition surrounding Obamacare and its effect on North Carolina is rooted in the principal ideals of the polarized sides relating to economics and the federal government’s role. One side, mainly associated with the Republicans, opposes Obamacare because it requires U.S. citizens to buy health care, does not address the cost of health insurance and will increase these costs, and gives the federal government more control over health care. The other side, that supports Obamacare, is associated with Democrats who support that everyone deserves affordable health care, those with higher incomes have higher costs, and the federal government has more regulation over health care. These ideas are at odds with each other, and the only even ground between the sides is the desire to reduce costs, yet the sides also conflict over how this can be done.

With Republican majorities in the House and Senate and a Republican governor, the NC General Assembly’s decision not to set up a state exchange to implement the Affordable Care Act largely reflect the party’s principles. Their reasoning behind this decision was based on the costs to the state the exchange would have added, conflicting with the current attempts to improve the state’s economy. With North Carolina’s struggling economy at risk, the General Assembly tried to avoid additional costs to the state. Democrats however, believe that the ACA will eventually reduce costs and that by not running the state’s exchange, new companies were dissuaded from entering the market resulting in little competition and high prices for consumers.

Republicans also see this as giving the federal government more control; in the health care market and over people’s everyday lives. Requiring people to have health insurance is seen as violating the rights of U.S. citizens, who should be able to decide what they do or do not buy. On the opposite side, the Democrats support this increase in government control and think that the requirement for all citizens to have health care allows more people to afford it as everyone will essentially be paying for everyone’s insurance through subsidies to the poor and increased costs to the rich.

Each side has a main focus that drives their support or opposition. For supporters of Obamacare that is the belief that everyone deserves affordable health care. Opponents of Obamacare do not neccessarily oppose this idea, but think the ACA does not address the cost of health care and will only increase spending while giving the federal government more control over people’s daily lives. The common ground between them is the desire to reduce the cost of health care, and if the two sides could come together to make a plan to do this more agreeable to both sides this could possibly bring an end to polarized sides. The two will never agree on how much power the federal government should have, but both want a more cost-effective health care system. The Affordable Care Act has many points that I think both sides agree on, but more contested aspects should be reviewed to help balance the costs of health care.

Little Competition May be Reason for High Rates

With only two health insurance companies, Blue Cross and Blue Shield and Coventry, offering plans through North Carolina’s health care exchange, the prices of health care plans are higher in some places than the national average. The prices of plans offered through the exchange vary greatly by area, but many areas in North Carolina, especially rural areas, are seeing higher rates. Differences in costs for medical care could be contributing to these variations. Prices for doctors and hospitals vary, as does the number of hospitals and doctors in a specific area. There are many variables that contribute to some areas having higher rates, but a major reason may be the lack of competition.

Blue Cross and Blue Shield almost has a monopoly on health care in North Carolina, and is the only carrier offering plans in all of the state’s 100 counties. It’s only competition is Coventry Care of North Carolina, however Coventry is only offering plans in 39 counties, leaving BCBS as the only provider in 61 counties. Several counties only have one available plan, and the prices in these areas are higher than those places where there are more plans offered. It could be argued that companies know which areas have more expensive medical care, and so they avoid those areas, but it has been observed in other areas and states with more competition that this helps to keep the rates down.

Despite the current lack of competition, other companies could end up entering North Carolina’s market. If the exchange appears successful to insurance companies, some may want to get involved to share this success. If more options are introduced into North Carolina’s exchange, this could help to create competition between companies, resulting in lower rates. However, it may prove difficult for new companies to get contracts for health services in order to enter the market.

Analysis

Introduction

The 2013 session of the North Carolina General Assembly passed bills addressing recent health care issues brought on by the Affordable Care Act, more commonly known as Obamacare. The Affordable Care Act was signed into law in 2010, but three years later the major stages are just now coming into effect. The general understanding is that the law requires U.S. citizens to have health care or pay a fine, however the bill is much more complicated than that. U.S. citizens are required to have health insurance, but can shop for plans through exchange programs, and individuals already with insurance may not be affected by Obamacare at all. States had to decide upon certain aspects of the act in preparation for the first major stage that began this year.

The aspects that North Carolina had to decide upon were the expansion of Medicaid and the installment of a health care exchange. The General Assembly refused the federal funding to expand Medicaid and also refused to set up a state-run health care exchange. The state has come under fire for both of these decisions, but much of the confusion and debate has been in regards to the health care exchanges.

The Affordable Care Act not only requires citizens to have health insurance, but calls for places where people can easily shop available health care plans. These places are called health care exchanges or marketplaces. Each state has an exchange where certain health insurance providers can offer plans, however the available plans, providers, and costs differ from state to state as well as within each state. The exchanges could either be run entirely by the individual states, in conjunction with the federal government, or entirely by the federal government. North Carolina was among the 36 states to refuse the exchanges, making the federal government in charge of the exchanges of those states.

Even as the federal government shut down after failing to agree on a budget, the health care exchanges opened on October 1st, giving North Carolinians their first look at the available plans. However, the North Carolina exchange had only two providers offering plans, only one offering plans for the whole state, and high rates. North Carolina is still struggling economically and has one of the highest rates of uninsured in the country, yet the health care exchanges in North Carolina have fewer options and higher rates than most of the other states, but the state government still faces challenges of informing the public about health care reforms.

North Carolina Exchange

The North Carolina state legislature refused to run the state’s health care exchange based on the cost to the already economically struggling state. Years after the economic downturn, North Carolina is still suffering economically. The state also has a large percentage of uninsured at 17.2% according to the U.S. Census Bureau. This ranks North Carolina in the bottom 15 states with the most uninsured. Many of these people cannot afford to pay for health insurance on their own, and so may be eligible for tax credits, subsidies, or Medicaid. With so many people needing aid in paying for the now-required insurance, the government may have to help in the payments, taking even more state funds. Health care rates in the exchange are above the national average and many people would not be able to afford the plans without subsidies. The health care rates in North Carolina, already high, are predicted to increase due to the taxes and fees required by the Affordable Care Act. Blue Cross and Blue Shield has already estimated that they will have to pay $69.7 million in insurance taxes in 2014, and that this will lead to an increase in cost to customers. BCBSNC has even sent out notices to their existing customers, alerting them to the fact that their rates could double or triple unless the customers qualify for subsidies that offset the increase in cost. For a state struggling economically, these added costs to both the state and citizens could have a detrimental effect. The North Carolina exchange has very few options for health care plans and providers. Blue Cross and Blue Shield of North Carolina and Coventry Health Care are the only two companies participating in North Carolina’s exchange, and Coventry does not offer plans for all counties. This lack of options has been attributed as the reason for the state’s higher rates.

North Carolina is not the only state in which Obamacare is predicted to increase the cost of health insurance despite Obamacare supporters’ claims of reduced costs. The main idea behind Obamacare is to provide affordable health care to those without health insurance. Proponents of Obamacare have stated that most low-income Americans will be able to get free or very low cost health plans through the exchanges. Taking into account a person’s eligibility for subsidies, tax credits, and Medicaid, Obamacare could have a very low cost. However, not everyone is eligible for these and due to the taxes and fees health insurance providers are required to pay, the rates will most likely increase and so these credits and subsidies may result in a person paying what they previously did for insurance. The experts working for Medicare’s actuary have predicted that Obamacare, in the first ten years, will raise the amount of money spent on health care by approximately $621 billion, or roughly an increase of $7,450 per family of four. These costs are not only increasing for families and individuals, but companies as well. Obamacare requires companies to provide health insurance for full-time employees or pay a fine for each uninsured employee. Well-known companies, such as Papa John’s and Olive Garden, have predicted higher prices and/or are considering moving employees from full-time to part-time to cut down on costs for providing their insurance. Unfortunately, a franchise owner of Five Guys in North Carolina has promised increased prices as a result of the new law.

Challenges

State officials have been criticized for not providing information as to how people can sign up for health care, however recently Governor Pat McCrory has helped in providing information for the exchange. Protect Your Care NC accused Governor Pat McCrory of trying to undermine the Affordable Care Act by passing the recent health care laws and not providing information for how the exchanges would work. McCrory responded that he had been determining the effects the Affordable Care Act would have individuals and businesses and would give an update the following week. Although more than a week later, McCrory did release an informational video about the exchange. He explained key elements of the ACA, including how to sign up for health care, the deadlines, and who did not need to use the exchange.

There is no evidence that North Carolina wanted to sabotage the Affordable Care Act, but NC did challenge its effects on the small group market. A bill was passed to reduce the impact the Affordable Care Act had on North Carolina’s small businesses. The bill changed the definition of a small employer to one who employs at least one, but no more than 50 employees on business days. The bill also included adding in the “grandfathered health plan” term.

Additional Troubles Surrounding Health Care

There is support for North Carolina’s recent health care laws, but there are also those that are critical of the laws. The laws passed by the General Assembly, in some ways, adversely affected women and their access to health care. If Medicaid had been expanded, more than 200,000 women in North Carolina would have had access to basic health care and the restrictions placed on abortion clinics by a new law closed 15 of the 16 clinics in North Carolina, reducing the access women had to this service.

The North Carolina Department of Health and Human Services was directly affected by the government shutdown and so was not able to be fully involved in the opening of the exchange. 337 DHHS employees were told not to come in to work, but unless a resolution is reached, more employees could be furloughed or have reduced hours. Many of the DHHS’s actions have ended, including funding for several programs that provided services for women and children.

Conclusion

The criticism of North Carolina’s recent health care laws and state officials have valid points, but many of the accusations are based on flawed logic. The state government does not run North Carolina’s health care exchange, and so I do not see how they are responsible for providing information on something they do not control. The reasons given for the rejection of a state-run exchange have been demonstrated as valid through numerous predictions as to the cost of the Affordable Care Act across the country. Once the exchanges opened, people could finally see the actual costs of the health plans available, and many were upset at how expensive the plans were and confused as to the system. The few options and high rates in North Carolina’s health care exchange provide support for the state’s refusal to run the exchange due to the costs, but the state government still faces challenges in providing information for the exchange, which they themselves are trying to figure out and do not have authority over.

How Does Government Shutdown Affect the ACA

The federal government partially shutdown yesterday, but how has it affected the Affordable Care Act? The short answer is that so far it hasn’t. The Affordable Care Act is at risk as Congress tries to pass its new budget, but for now the Affordable Care Act is on to the new stage. As the government shut down on October 1st, the health care exchanges opened as planned and will continue as the ACA’s functioning, even with a government shutdown, was written into the bill.

The new exchanges, or marketplaces, are now up and running, but many people don’t know what they are. The health care exchanges are places where individuals, families, and employers can shop for health care plans for themselves or their employees if they don’t already have health insurance. Most people get their health insurance through their work and these will not need to use the marketplaces, just people without healthcare. The exchanges can be accessed in person at enrollment locations in your community (you can find yours at localhelp.healthcare.gov), online at Healthcare.gov, or on the phone. There are “navigators” available to help people sign up. People cannot sign up for a plan on the exchanges, but will call the insurance companies themselves to sign up after choosing the plan they want through the exchanges. December 15th is the deadline for purchasing insurance plans. Although people can start signing up for health insurance at the exchanges as of Tuesday, the insurance doesn’t actually kick into effect until January 1st.

Although the Affordable Care Act is moving along as planned, many other public health services have been affected by the government shutdown. The Department of Health and Human Services has deemed 52% of its employees unessential and they have been sent home. Federal health and safety worked deemed essential will continue throughout the government shutdown such as disability benefits, the National Weather Service, and most of the Federal Emergency Management Agency’s disaster recovery services. However, other services have been entirely or partially suspended. National Institutes of Health will not admit new patients, not take actions on grant applications or awards, and discontinue some veterinary services. There will be less recertification and initial surveys done by the Centers for Medicare and Medicaid Services for Medicare and Medicaid providers.

This website provides more information on Health and Human Services actions in starting up the exchanges:http://abcnews.go.com/blogs/politics/2013/09/even-with-threat-of-shutdown-health-care-exchanges-ready-to-go/

A lot of other public health services are being affected by the government shutdown which can affect people’s access to health care services, even in North Carolina. The scariest one, to me anyway, is that the Centers for Disease Control and Prevention have halted their outbreak detection program (can anyone else see this as the start of a zombie apocalypse?). The following website provides more information: http://www.publichealthnewswire.org/?p=8674 

Bills on Access to Specific Health Care Options

In July, the North Carolina General Assembly passed several bills relating to health care, including bills on abortion restrictions and mental health. Both were surrounded by controversy as claims that the bills restricted access to these aspects of health care.

The Health and Safety Law Changes required stricter regulations and enforcement of these regulations for abortion clinics. While supporters of the bill claimed the purpose was to ensure the safety of patients, opposition saw it as purposefully limiting women’s access to abortion as the regulations closed down most clinics. The bill also keeps abortion from being covered by taxpayer-funded health care plans. I agree with the latter portion of the bill, as I think taxpayer-funded health care plans should only cover necessary health care and unless the pregnancy will be harmful to the mother I do not think abortion is a necessary aspect of health care. I’m not sure what to think of the stricter abortion clinic regulations as I don’t know the conditions of the regulations or of the clinics and whether or not the regulations are reasonable.

A Senate bill passed gave clearer indication of how individuals with mental health issues can file grievances when denied services. However, the issue with this bill was raised by Senator Ellie Kinnaird who was disconcerted by the phrasing which puts emphasis on the individual proving the denied service was necessary rather than the managed care organizations (MCOs) proving that the service was not necessary and the denial therefore validated. This places more burden on the individual contesting the decision rather than the experts, the MCOs. This could potentially limit individuals’ access to necessary services that they were denied as the contest is based on the individual’s proof while they may not know how to do so as well as an expert MCO.

These bills as well as one on requiring drug screening for NC welfare applicants are further described in the following article: http://www.northcarolinahealthnews.org/2013/07/26/health-care-bills-clearn-final-legislative-hurdles/

ég anda, ég skapa, ég elska

I breathe, I create, I love