Community Calendar: December

UNITED STATES – November 29, 2023 – Although there is no place in the United States where everyone has health insurance and, therefore, access to health care, there are ten states where the uninsured rate is less than 5 percent. About 26 million Americans (about 8 percent of the population) do not have health insurance. However, in 2010, the year that the Affordable Care Act (ACA) became law, there were more than 46 million uninsured Americans. Therefore, 20 million Americans have obtained health insurance after the enactment of the ACA in 2013. The ACA reduced the coverage gap between the government-funded Medicaid insurance for persons with low resources and those with commercial health insurance. It expanded Medicaid on a state-by-state basis and offered government subsidized commercial health plans to full-time workers and their families who did not qualify for private health insurance and allows people with pre-existent health conditions to obtain coverage.

According to 2022 data, the KFF reports that of the 50 states, the District of Columbia, and Puerto Rico, these are the top 10 jurisdictions with less than a 5 percent uninsured rate:

1. Massachusetts
2. District of Columbia
3. Hawaii
4. Vermont
5. Iowa
6. Rhode Island
7. Minnesota
8. New Hampshire
9. Michigan
10. New York

Of the states below the national average: North Carolina is 42^nd with 9.4%; Florida is 48^th at over 11%; and Texas is last with almost a 17 percent uninsured rate. A very interesting finding is that New Mexico is at the national average of 8 percent; but, in 2010, 23 percent of its population was uninsured.

It has been estimated that more than one-half of the uninsured are eligible for Medicaid or the ACA health plans. The most successful states have implemented specific policies that have expanded coverage. Massachusetts and New Mexico integrate the enrollment process for Medicaid and the ACA health plans and offer state-based financial assistance in addition to the federal subsidies. The ACA allows Minnesota and New York to offer a state-sponsored Basic Health Plans to persons who fall in the healthcare gap. The states were able to use the money saved by enrolling Medicaid beneficiaries into Medicaid managed care plans rather than the traditional fee-for-service model. Colorado and Washington promote the ACA health plans and offer some subsidies to undocumented immigrants whose earnings would qualify them for Medicaid expansion.

The percentage of uninsured Americans is greater than most of the world’s developed nations. The U.S. healthcare system has the most expensive cost of care on a per capita basis, yet is the 37^th ranked country in quality of care. Health insurance provides people with some financial protection against expenses, but does not cover all of the bills. It provides hospitals and providers with some compensation for their efforts and services and sustains the bottom line.

Improving access to healthcare is one great step towards providing access for everyone, reducing medical debt and bankruptcies, and eliminating health disparities. Universal healthcare may be an aspiration rather than reality in this political climate. However, if each state diligently pursues signing up everyone who is eligible for Medicaid expansion and the ACA health plans, then there will be far fewer uninsured Americans.

According to Larry Levitt, executive vice president at the KFF health policy think tank, “No state has put all the pieces together to the full extent available under the ACA.”

Listen to the full report below:

Contact: Dr. Dick Needleman, Health reporter, 103.3 AshevilleFM, [email protected]

RALIEGH, NC – December 1, 2023 – On December 1^st, North Carolina officially became the 40^th state to expand Medicaid. A state Medicaid expansion (ME) bill was passed by the General Assembly and signed by the Governor in March_. However, the bill was tied directly to agreeing upon the 2023-24 state budget. On September 27^th, the Republican-dominated North Carolina General Assembly passed the 2023-24 state budget so that the state could expand Medicaid as soon as feasible. There are now 10 states that have not expanded Medicaid as recommended in the Affordable Care Act of 2010 and left to each state to decide in a subsequent Supreme Court ruling.

ME increases health care access to eligible North Carolinians ages 19-64 and their families making up to 138 percent of the federal poverty level up from 100 percent. It is estimated that 600 thousand more North Carolinians will be eligible for Medicaid, including almost 17 thousand people from Buncombe County. Medicaid is the federal program for health insurance for low-resource individuals. Statewide and countywide preparation has included enrollment events, training for groups that provide services to Medicaid beneficiaries, and hiring staff to register eligible people.

The North Carolina Department of Health and Human Services (HHS) were able to fast-track ME enrollment for about 300 thousand people (one-half of the eligible persons). This group recently lost their Medicaid insurance after the federal COVID era rules for keeping people on Medicaid during the pandemic ended on April 1^st. As a result, each state was allowed to remove people if they made too much money to qualify. However, North Carolina has a limited Medicaid benefit that provides for family planning benefits for people who make up to 195 percent of the federal poverty level. Therefore, HHS enrolled these 300 hundred thousand people in this limited benefit plan and will automatically enroll them in the full-benefit Medicaid plan soon.

Expanding Medicaid will bring 8 billion federal dollars annually to the state and almost 2 billion dollars to support behavioral health, public safety, and rural health care. North Carolina will receive an almost 2 billion dollars incentive of federal funds for starting the program this year.

Beginning December 1^st, people can apply for Medicaid online and at any time at ePASS.NC.gov. Applications can be done in-person at the HHS Building on 40 Coxe Avenue in downtown Asheville, by calling 828-250-5500, or by mail.

The Buncombe County HHS is sponsoring a kickoff event on Tuesday December 12^th from 11 AM to 1 PM at the East Asheville Library at 3 Avon Road in Asheville. HHS staff will be there to answer questions and help with online applications.

Listen to the full report below:

Contact: Dr. Dick Needleman, Health reporter, 103.3 AshevilleFM, [email protected]

ASHEVILLE, NC –  December 6, 2023 – The COVID-19 metrics are on the CDC’s COVID Dashboard. For the week ending on November 25^th:

• Hospital admission levels are low in 99 of 100 counties in North Carolina, including Buncombe County, and about 80% of the counties in the U.S. However, they have increased in North Carolina and increased in Buncombe County from the previous week.
• Fewer than 10 deaths in North Carolina were due to COVID, the lowest level of 6 groups.
• Emergency room visits for COVID-19 are low in North Carolina. This represents about 2.0% of all ER visits, the 2^nd lowest of 5 levels and stable from the previous week.

Wastewater monitoring can be used to provide early warning for COVID outbreaks. The Buncombe & Henderson counties wastewater data for the week ending on November 15^th and updated on November 29^th is on the North Carolina COVID Dashboard.

• The number of viral gene copies in each water sample is at a red level representing the highest level of 5 groups, currently between the 80^th and 100^th percentile relative to the past level measured at the same site.
• The 15-day rate of change of the number of viral gene copies in each water sample has increased from the previous week, at 10% to 99%, the middle level of 3 groups for a positive rate of change.

Listen to the full report below:

Contact: Dr. Dick Needleman, Health reporter, 103.3 AshevilleFM, [email protected]