Former Arkansas surgeon general brags on Medicaid expansion

I have written often about the Affordable Care Act not being fully implemented since 15 states have not expanded Medicaid. Rather than repeat my arguments, let me reference the attached editorial written by Dr. Joe Thompson, the former Surgeon General of Arkansas, which I read in Friday’s The Charlotte Observer. The reason for their interest is North Carolina has a Democrat governor working with a Republican majority General Assembly and the issue of Medicaid expansion is of importance. The editorial is entitled “Medicaid expansion works in deep red Arkansas. It would work in North Carolina too.”

“My home state of Arkansas is unusual among Southern states in having adopted Medicaid expansion early and in our own fashion.

I was Arkansas’ surgeon general in 2013 when the state first faced the question of whether to expand Medicaid. Like North Carolina now, Arkansas then had a Democratic governor and a Republican-controlled legislature. Fortunately, we avoided an impasse; lawmakers on both sides of the aisle came together to approve an innovative alternative to traditional Medicaid expansion that provides private health insurance coverage to about 250,000 people earning up to 138% of the federal poverty level.

The effect on Arkansas’ uninsured rate was swift and dramatic. A 2015 Gallup report showed that since Arkansas’ Medicaid expansion program took effect in January 2014, the state’s uninsured rate had been cut roughly in half, dropping from 22.5% to 11.4% ― the biggest reduction in the nation.

According to the U.S. Census Bureau, Arkansas’ uninsured rate was 8.2% in 2018. North Carolina’s was 10.7%, the ninth-highest rate in the nation. Arkansas’ reduced uninsured rate led to a 55% reduction in uncompensated-care losses at hospitals. This has been especially important for rural hospitals, which treat many low-income patients.

Since January 2010, only one rural Arkansas hospital has closed for financial reasons. In the five neighboring states that have not expanded Medicaid, more than 50 rural hospitals have closed, according to the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill.

Expanding Medicaid also has helped stabilize Arkansas’ health insurance market, improve competition and control premiums. Since 2014, at least three insurers have offered plans through the Health Insurance Marketplace in each county in the state. The competition encourages low rates: In 2014, 38 states had marketplace premiums lower than Arkansas’; today, only six states have lower premiums.Medicaid expansion has brought billions of new federal dollars into Arkansas’ economy: $1.7 billion between January 2014 and June 2015 alone, according to the Kaiser Family Foundation. Arkansas also is saving money because some individuals previously covered under traditional Medicaid, which in Arkansas is 30% state and 70% federally funded, are now covered under Medicaid expansion.

The federal government currently is paying 93% of Medicaid expansion costs and will pay 90% in 2020 and thereafter. A consultant told a legislative task force in 2016 that Medicaid expansion would save Arkansas $757 million between 2017 and 2021.Thirty-six states have now decided to accept Medicaid expansion.

Arkansas has become a firmly red state, but it has reauthorized its Medicaid expansion program with a supermajority vote every year because of the demonstrated benefits to the working poor, the economy and the health care infrastructure. Last year, Arkansas added a work and community engagement requirement that currently is blocked by a federal judge’s order, but however that issue ultimately is resolved, it is clear that Medicaid expansion has had tangible, positive results. There’s a reason the number of states rejecting it continues to shrink each year.

Joe Thompson, MD, MPH, is president and CEO of the Arkansas Center for Health Improvement. He was Arkansas’ surgeon general under Republican Gov. Mike Huckabee and Democratic Gov. Mike Beebe.”

In spite of efforts to naysay it, hobble it and kill it, the Affordable Care Act is stabilizing some. It needs more stability and Medicaid expansion would help in the remaining 15 states. I have also advocated the US government paying back the money they withheld from insurers causing some to leave the market, inviting those companies back to the market. I have also advocated the reduction of the Medicare eligibility age from 65 to age 62 or even 60. And, where options don’t exist, Medicare could be offered as an option for younger adults.

What frustrates this retired benefits manager, consultant and actuary is the fact people getting harmed by decisions to harm the ACA is not a major factor. There is too much focus on winning an argument that people getting screwed does not seem to matter. Please help make it matter. Even as we speak, the eating away at the edges of the ACA could lead the Supreme Court to rule it unconstitutional. If this occurs it would be a damn shame.

Medicaid expansion is needed for NC says this retired benefits professional

As North Carolina continues its stalemate on Medicaid expansion, it might be interesting to heed the words of former Ohio Republican governor John Kasich. When Ohio moved forward with the Medicaid expansion, he called it a “no brainer.”

Now why would he say that? Kasich noted Medicaid expansion would not only help people, it would bring $13 billion to his state over several years. George Washington University did a study that said Medicaid expansion would help a state’s economy, help a state’s rural hospitals and help people. We should also remember NC Republican Mayor Adam O’Neal of Belhaven walking to Washington seeking the expansion of Medicaid after his colleagues in Raleigh turned him down as he tried to save his town’s hospital.

Rather than offer stale arguments, it would be nice if the Senate and House leaders figure out a way to get this done. Let me add the voices of The Commonwealth Fund, RAND Corporation and Economic Policy Institute that echo the results of the GWU study. NC is already in the minority on this. Please let’s find a way to help people.

Let me close with a truism about health coverage to think about. Those with coverage will see doctors earlier and will have access to prescription drugs to avoid future train wrecks. Preventive care and health maintenance are better paths forward for people and healthcare financing.

Note: The author of this post is a retired benefits professional who is a former actuary, former benefits consultant and benefits manager for a Fortune 500 company

The most realistic path to ‘Medicare for All’ says a former Insurance CEO

I said back in 2010 to a healthcare consulting colleague, we will eventually need to consider national health insurance, but it won’t happen. When he asked why, I responded the “Healthcare industrial complex is too powerful.” People forget the reason we have the Affordable Care Act is CFOs were tired of rising healthcare costs to their bottom line.

Healthcare is a complex topic and the ACA added to that complexity. It has since gotten better, but we need to shore it up to stabilize it more, rather continue to allow it to be diminished as its opponents have down for several years.

But, national health care under the banner of “Medicare for All” is worthy of consideration with data and analysis. This retired actuary, benefits consultant and benefits manager supports data driven analysis to improve what we have and consider more substantive changes. JB Silvers, a former health insurance CEO and professor of health care finance at Case Western University, penned an article called “The most realistic path to ‘Medicare for All'” in The New York Times earlier this month. Here are excerpts from the article:

“Much to the dismay of single-payer advocates, our current health insurance system is likely to end with a whimper, not a bang. The average person simply prefers what we know versus the bureaucracy we fear.

But for entirely practical reasons, we might yet end up with a form of Medicare for All. Private health insurance is failing in slow motion, and all signs are that it will continue. It was for similar reasons that we got Medicare in 1965. Private insurance, under the crushing weight of chronic conditions and technologic breakthroughs (especially genetics), will increasingly be a losing proposition.

As a former health insurance company C.E.O., I know how insurance is supposed to work: It has to be reasonably priced, spread risks across a pool of policyholders and pay claims when needed. When companies can’t do those fundamental tasks and make a decent profit is when we will get single payer.

It’s already a tough business to be in. Right now the payment system for health care is just a mess. For every dollar of premium, administrative costs absorb up to 20 percent. That’s just too high, and it’s not the only reason for dissatisfaction.

Patients hate paying for cost-sharing in the form of deductibles and copays. Furthermore, narrow networks with a limited number of doctors and hospitals are good for insurers, because it gives them bargaining power, but patients are often left frustrated and hit with surprise bills.

As bad as these problems are, most people are afraid of losing coverage through their employers in favor of a government-run plan. Thus inertia wins — for now.

But there’s a reason Medicare for All is even a possibility: Most people like Medicare. It works reasonably well. And what could drive changes to our current arrangement is a disruption — like the collapse of private insurance.

There are two things insurers hate to do — take risks and pay claims. Before Affordable Care Act regulations, insurance companies cherry-picked for lower-risk customers and charged excessive rates for some enrollees…”

There is only one solution: pooling and financing many of the risks related to chronic and acute health care issues. A study by my former company noted generally 15% of participants drive 80% of the claims costs in any given year. It may not be the same 15%, but with major chronic issues, some could continue to be in the mix. The principle of insurance is to pool those risks, so that good risks can moderate the higher risks.

The ACA uses the private insurance system, exchanges and expanded Medicaid. Unfortunately, there are about 15 states who still have not expanded Medicaid. Medicare for All would consolidate the risk into one place, eliminating the profit load and reducing the relative administration cost of insurance companies. I have suggested for several years to do a pilot and expanded Medicare eligibility from age 65 to age 62, or even lower. This would let us measure the impact of such a change.

Yet, what we don’t need is this to become political. What people do not realize is the ACA has been sabotaged on several occasions by my former party which drove some insurers out of the market and increased premiums for everyone else more so than they otherwise would have been.

So, let’s cut to the chase and study options. And, politicians should let people who know what they are doing do the analysis. The ACA was made too complex and the exchange roll out was botched. On the flip side, what the GOP did in 2017 was sloppy and poorly staffed, so what was voted on woulf have been harmful to many.

Our children deserve better

Two time Pulitzer Prize winner Nicholas Kristof wrote an editorial earlier this week in The New York Times called “Our children deserve better.” It is a clarion call to our nation showing the plight of kids in America.

Here are a few quotes to frame the issue:

“UNICEF says America ranks No. 37 among countries in well-being of children, and Save the Children puts the United States at No. 36. European countries dominate the top places.

American infants at last count were 76 percent more likely to die in their first year than children in other advanced countries, according to an article last year in the journal Health Affairs. We would save the lives of 20,000 American children each year if we could just achieve the same child mortality rates as the rest of the rich world.”

“Half a million American kids also suffer lead poisoning each year, and the youth suicide rate is at its highest level on record….The Census Bureau reported this week that the number of uninsured children increased by 425,000 last year.”

These are different views and sources of the threats to US children that note we have a problem. Another source I read a couple of years ago noted America has a much higher maternal mortality rate at child birth than other civilized countries, which further endangers children as well as the mothers.

Yet, these issues are not being discussed in the halls of government. We have a poverty problem in our country with too many living in or just above poverty levels. We have not expanded Medicaid in fifteen states whose numbers are worse than these national numbers per capita. We have not addressed our national water crisis which has a Flint, MI like exposure to lead in too many cities and a volume of available fresh water issue in other places. We have not invested as we should to diminish crime and provide more opportunities for jobs in disenfranchised areas. There are several pockets of success that can be emulated in more cities.

We also need to address better gun governance, especially with the number one gun death cause by far being suicide and a non-inconsequential accidental gun death rate. And, we have not dealt with the continuing and rising exposure to technology and artificial intelligence which have taken and will take even more jobs in the future. Finally, there is that climate change thing we need to deal with.

These are real problems. And, they will get worse. Data driven analysis of causes and solutions are needed. They are both multi-faceted. Investing more now, will save huge amounts later. This is not just an urban issue, it is rural one as well. The opioid crisis is rampant in these impoverished rural areas, for example.

None of the solutions will fit on a bumper sticker. And, political attempts to oversimplify issues should be questioned. Here is an easy contradiction to spot – if people believe gun deaths are a mental health issue, then why the effort to eliminate or not expand mental health benefits?

Please make your legislators aware of these issues and ask pointed questions. These questions deserve answers, not bumper sticker slogans. These concerns deserve to be talked about, studied and acted upon.

Tantrums, vapes, and hurricanes

The week that was had serious issues that threatened the lives of people mixed in with self-inflicted issues that caused temper-tantrums. In no particular order:

The Bahamas was truly devastated by Hurricane Dorian. The aftermath pictures are sobering. Okracoke, one of the southernmost Outer Banks islands in North Carolina, was hit hard, but the US mainland was spared the brunt of the storm, although damage occurred and lives were lost. That is the big story.

Yet, way too much time and effort has been spent trying to save face for the US president after ham-handed and unneeded efforts to play weatherman. Rather than admit he over accentuated the threat on Alabama, he had his staff spending valuable time coming up with a story that does not let the president’s little feelings to be hurt. What he fails to realize, it is the “rationalization” efforts that paint him in a bad light. It is akin to dressing up the “dog ate my homework” excuse.

Since we are talking about blowing smoke, the dangers of vaping are raising their ugly head. More kids are entering the hospital with breathing concerns traceable to some form of vaping. What has always concerned me is the amount of smoke the vapers exhale from their lungs. It far exceeds the amount of smoke a cigarette smoker would exhale. Call me crazy, but that cannot be good for one’s health.

Still on the subject of blowing smoke, ex-president of Zimbabwe, Robert Mugabe died yesterday at the age of 95. After being initially praised for liberating and founding Zimbabwe, he proceeded to kill any opposition and become an autocrat. While so doing, he blew smoke at the world to mask his efforts.

Our British friends are realizing that having Boris as prime minister is not necessarily a good thing. Even pro-Brexit folks are likely lamenting this ego-centric choice. When time is of the essence, shortening the time to discuss a complex topic is not good stewardship. But, all of Parliament needs a “get out of the pool” order to allow them to check their egos, decide what they want and get their fannies to Brussels. A no-deal Brexit would be disastrous and would be felt immediately.

Finally, the US president acted on another temper-tantrum when the Department of Justice sued the State of California and four automakers for an agreement to comply with a higher mph standard than the Federal government wants. These automakers feel being good stewards will help sell cars and help them compete with other automakers. It is sad that Attorney General William Barr has stained his career being the president’s personal attorney and attacking people that disagree with him – that is autocratic behavior.

Have a great weekend all.

Colorado Family Planning Initiative

As the veracity of Planned Parenthood is being discussed, there is a program and study that was conducted in Colorado over a seven year period that offers meaningful data. The Colorado Family Planning Initiative offered low-income women and teens access to low or no-cost contraception, including IUDs and implants.

The Governor’s office released the results of the program which analyzed data from 2009 – 2013. The key findings are:

  • there was a 40% statewide decline in the teen birth rate
  • there was a 35% statewide decline in the abortion rate

If the goal is to reduce the number of unwanted pregnancies and abortions, funding the use of contraception along with family planning efforts and information is the better answer. Cutting funding will only increase these numbers. And, it should be noted there are correlations between poverty and increasing family size and poverty and single mothers. This is more true the younger the mother.

Education is a vital part of the program as well. If people want to teach abstinence as part of a holsitic program, that is fine. But, the teachers and funders need to clearly understand these teens and young adults are just like we were, if not more so. They are tempted and will have sex. It would be so much the better, if they were informed of the consequences and knew what options there were.

A key part of the education must help girls understand that self-esteem need not be tied to sex. These girls need to be able to say no and feel confident in withstanding pressure, especially today with so many ads, shows, and stars (by dress and manner) saying it is OK. And, boys need to know that no means no. It can be uttered up to the time in which sex occurs.

As a parent, I know parents worry about their kids. You hope they will make good choices. Yet, we did not always make them and they will likely follow suit. Also, please understand even kids brought up in the strictest of homes will be tempted to do things when away at school or college. It is only natural.

Three anecdotes might help illustrate the importance of education and planning.

  • My brother-in-law taught eighth grade science in a high poverty rural area. Annually, he had a number of girls in his class get pregnant. To them, it was being like an adult a right of passage. Only when it was too late, did they realize the consequences.
  • A colleague was viewed by teens in her church as being the kind of person who would shoot straight with them. She was asked questions that told her these kids thought they could not get pregnant the first time and if they had sex standing up they could avoid pregnancy. When she mentioned to the minister to have a sex education class, he scoffed at her request.
  • A friend who has run several non-profits and is very devout told me the children of his friends would go off to a religious university nearby. He said these kids would go wild when finally away from their parents and shocked some of his friends by what they got into.

So, Planned Parenthood and organizations that provide holistic family planning need more funding to reduce the number of abortions and unwanted pregnancies. Kids need to get good information and access to tools. It is their lives. And, while I focused on pregnancies, STDs and HIV are very viable threats to manage through contraception and education.

Let me close with this thought. As the former Board Chair of an organization that helps homeless working families, single mothers is the predominant group that is helped. It is also the fastest growing homeless population in America. Key tools to help lessen the propensity of poverty and homelessness in this group are family planning, sex education and low-cost birth control.

Perception matters more than reality to the US president

Our friend Jill has written an excellent post on “Trumponomics 101” (a link is provided below). What I opined in a comment is Trump is more about perception than reality. Here are a few examples:

– he beats his chest on his trade and tariff decisions, but they have dampened the global economy, of which we are a key part, as well as certain US industries.

– he left the Trans Pacific Partnership which was designed to compete better with China on trade (note the other ten countries proceeded without us).

– he claims being tough on immigration and terror, but his travel ban and reduction in legal immigration are dilutive to our economy (note legal immigration has fallen as well).

– he touts his tax law, but it borrowed from our future to make a pretty good economy a little better for eighteen months or so.

Focusing on another tax cut to lessen the impact of the slowing growth is malfeasance, as was the first tax cut in December, 2017. And, lowering interest rates won’t push a lot of investment as businesses are concerned by the chaos caused by Trump.

So, Trump is worried about the market and economy retrenching from its growth not recognizing the headwinds he created. Note, for brevity I did not speak to other headwinds – not investing more in renewables, infrastructure, healthcare, etc.

Yet, the biggest perception he painted to his followers before the election was the US economy was in trouble citing the unemployment rate at 30%, then 40% then 42%. The reality is the unemployment rate was beneath 5% and we were in an economic growth period of 90 consecutive months (7 1/2 years) which continues to this day. He convinced his followers that he alone helped turn the economy around, which was doing pretty good.

Reality does matter. And, you won’t get a lot of that from Trump, who had a faux reality TV show.

Trumponomics 101