North Carolina & The Affordable Care Act- A Love Hate Relationship

With so much talk about the new changes that would come into effect January 1, 2014 when the Affordable Care Act (or Obamacare as some call it) officially became an enforceable law in America. Some haven’t really given much thought to any of it at all. While others are tired of hearing about it all together. There has also been much talk around the state of NC, especially since we were one of about 25 states that opted to decline federal funding to expand Medicaid. Many in the healthcare industry have mixed feelings. However still quite a few wonder what things would be like if our state had made some different decisions. It is estimated that if NC had participated in the Medicaid expansion around 500,000 individuals & families would have become eligible to enroll in Medicaid. This would have also helped to reduce the number of uninsured North Carolinians as well, which is estimated to be around 1.5 million. It also would have helped to create some competition among the private insurance companies that decided to participate in the federal insurance exchange marketplace. (There was only one company that decided to participate.) 

In October 2013 at a speaking engagement in Washington D.C., North Carolina Gov. Pat McCrory cited a couple of concerns such as adding an additional 500,000 people to the state’s Medicaid program & also concern over whether or not the federal government would actually pay its portion of the cost of the program after the first 3 years as factors in why he ultimately chose to decline the federal funds for the Medicaid Expansion. saysnorthcarolina.html#.UuR4_WQo7BIThe Governor also admitted that due to another new piece of federal legislation that had recently become law, NC may not have a choice but to reconsider the Medicaid Expansion. The new federal law allows hospitals to make “presumptive eligibility” decisions for those uninsured patients they feel may qualify for Medicaid under the current NC Medicaid eligibility requirements. Based on the “presumptive” decisions made by hospital personnel the state can be billed for services received by the patient until a final decision is made, which can take up to 60 days. In the event that the hospital has made the wrong decision about a patient and their ability to qualify for Medicaid the state still has to pay for any services the patient received prior to a final decision made about their Medicaid eligibility, regardless of the fact that ultimately they did not qualify for services.

Although many might believe that not excepting federal funding for expanding Medicaid in NC was a good decision. When you think about the amount of money that hospitals across the state end up attempting to collect every year from those that are uninsured, it makes one wonder if some of the expenses can’t be avoided or decreased. It is estimated that within the first 8 years of expanding Medicaid an estimated $65 million could have been saved by providing coverage to those who would typically be uninsured. The North Carolina Hospital Association is even encouraging our Governor to reconsider his position on the Medicaid Expansion. The Hospital Association feels that this is an opportunity for hospitals to be compensated for services they provide (which they would normally be providing for free.) They also point out that expanding Medicaid would also be an opportunity to provide primary care to those who utilize emergency rooms across the state for non-emergent care regularly thus providing access to primary care for everyone & hopefully helping to close the gap in the access to care.

At the end of December 2013 our state ranked 6 out of all the states with individuals or families using the federal exchange marketplace to enroll in some type of healthcare coverage. According to the data in a New York Times article, there were a little more than 274,000 people enrolled in our state. Out of that number only a little more than 31,000 of them were found to qualify for Medicaid or CHIP (a type of medical insurance assistance program for children from the government.) It seems like the residents of this state want affordable health insurance, improved access to care, and they don’t mind paying for it either.

When you consider the fact that the state has to budget for Medicaid expenses annually any way and one of the purposes of declining federal funding was to save NC money, you begin to wonder if that is still possible with some the new developments since the Governor made his decision. If the state will now be responsible for unknown amounts of hospital expenses regardless of whether or not an individual actually qualifies for Medicaid; you wonder will this plan lead to savings for the state? Or will this cost the state more in the long run? Will Gov. McCrory end up trying to get others in his party to reconsider accepting federal funding for the state to expand Medicaid? (Many believe this would be very difficult and therefore is very unlikely.) Whatever happens NC is sure to continue experiencing some growing pains with all of the changes that are sure to come as far as healthcare is concerned.

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