Negotiating our care in a broken system

Mission Health System, the largest hospital and the largest employer here in the Asheville region, has announced it may leave the Blue Cross Blue Shield of North Carolina network in October.

That has a lot of people in a panic, since Mission is our only option here and BCBS is pretty much the only insurer in the state — three-quarters of all people with health insurance here have it through them.

Leaving the network would mean closing the hospital. It couldn’t survive because it wouldn’t be able to collect the money it’s owed by patients whose insurance only covers half the cost of their bills.

On the other hand, this dramatic announcement allows Mission to tell the public how desperate things are becoming here.

Here’s why: Our state’s legislature has rejected the billions in federal dollars to expand Medicaid.

Before the Affordable Care Act, the federal government reimbursed hospitals and clinics for the money they spent caring for people who couldn’t pay. The ACA’s provision for expanding Medicaid was meant to replace this money, but the Supreme Court ruled that Medicaid expansion couldn’t be mandatory, so mostly Republican states, mostly in the South, decided to shoot themselves in the foot and not expand.

Now, we’re still paying our full share into the Medicaid expansion pot, but not a penny of that money is coming back into North Carolina. Instead, it’s going to states like Arizona that have expanded Medicaid, and North Carolina’s hospitals are losing billions of dollars a year.

What’s worse is that about five people in this state die every single day — up to 2,000 a year — from lack of access to care.

Instead of lobbying the legislature to expand Medicaid, BCBS is insisting this is not its problem, and Mission is left to try and survive by cutting services.

Already, several small hospitals in the state have either closed or been bought up by larger hospital systems like Mission that can weather the storm longer than they can.

But this can’t continue. Eventually, even the wealthiest people here won’t have access to services because they won’t be available.

I know this tactic of brinksmanship. I saw it as a reporter. I would get press releases from the hospital claiming the insurance company wanted to reduce rates to the point where the hospital wouldn’t be able to survive. On the other hand, I got press releases from the insurance companies saying the hospital was guilty of gross inefficiency.

Once the contracts were signed, usually within days of the deadline, everyone was buddy-buddy again.

One year, the CEO of BCBS came to Asheville for a Chamber of Commerce event and praised Mission as one of the most efficient hospitals in the nation. This was just four months after a press release with the same CEO saying Mission was one of the worst.

So, with press release in hand, I approached him after his speech and asked if he had any thoughts on Mission’s dramatic turnaround in just four months.

He had no comment.

This is a game — a dangerous game with human beings as pawns, but a game nevertheless.

The hospital needs higher reimbursements to cover the losses from the state legislature’s recalcitrant position. The insurance company can’t keep paying more without some serious rate hikes.

Everyone involved here is guilty of greed or of trying to make a political point at the expense of human life.

It is all deeply, deeply immoral, but I think people need to understand who’s at fault here and what could happen.

The Affordable Care Act isn’t perfect, but it’s better than what we had before. The rate of people with insurance are at an historic high in the country right now. If all the states expanded Medicaid, insured rates would be over 90 percent.

In states that have expanded Medicaid, insurance rates are rising far more slowly and health care expenses are leveling off. In states like this one, health care costs continue to spiral out of control and people continue to die.

So, who’s pro-life now?

 

I can’t believe I’m still protesting this …

Photo by Phil Fonville. We gathered on Bicentennial Mall in Raleigh Tuesday to protest the lack of affordable health care for a half million people in this state.

 

I realized a couple weeks ago that I’ve been protesting war, poverty and misogyny for a half century.

I mentioned it to Rev. William Barber, who will leave the NC NAACP presidency next month to head the resurrection of Martin Luther King’s Poor People’s Campaign. King started the Poor People’s Campaign 50 years ago, and now I get to work with Rev. Barber to help revive it.

Rev. Barber, who’s 10 years younger than I am, just smiled, put his arm around my shoulders and told me he loves me for my passion.

A half century of trying to make things better and we’re headed right back to where we started, with incarceration as the new slavery, with women being shut out from decisions about their bodies, with voting rights skewed toward the wealthy and white, with children going to bed hungry, elders having to choose between food and vital medications, with wages far too low to cover necessities, with the poor and sick blamed for their plight and with war looming on the horizon.

I am horrified by the state of things, but I cannot give up. I stand with the photo of my late son and explain to anyone who asks that he died from lack of access to care.

So, even in the pouring rain, I went to the rally, and, as so often happens at Moral Monday rallies, the rain let up for the two hours we were there.

But, as so often happens with Moral Monday events, the legislators left early and locked up the building rather than risk having to talk to any of us. So, we had a huge poster with a few facts about what their refusal to expand Medicaid has done to this state, and the 200-plus people who attended the rally each signed it.

We left it tacked to the front door of the building as the chief off the General Assembly police looked on. It’s OK — he’s used to us and seems to bear us no ill will, but he will arrest us if told to do so. He has arrested me twice — so far.

Anyway, because we couldn’t get into the building last night, we will be back next Tuesday, and we will go into the building and sit down and wait to address our legislators, as is our right under the North Carolina State Constitution. They might arrest us again, but we will not back down. Lives are at stake here — a half million of them.

If you want to participate in the sit-in, be at the Bicentennial Mall (across the street from the General Assembly Building) at 10 a.m. next Tuesday. If you can’t participate in the sit-in, you can still attend the health care rally at 6 p.m.

 

 

 

It was like talking to a wall.

 

me_n_pat.jpg

I had a choice this morning. I could stand with protesters outside the Governor’s Western Residence in Asheville or I could try to get into the open house to address him personally.

I decided to try and get to him.

We started driving to the residence, but when we turned up Town Mountain Road, we were told we’d never get in unless we went to First Baptist Church and waited for the shuttle.

We waited for almost an hour. The event was supposed to start at 9:30, but we didn’t get onto the shuttle until 10:20. When we got to the house, we were told we had 15 minutes, so I went outside, where the governor was standing beside the fire pit.

I approached.

“Hi, I’m Pat,” he said.

“I’m Leslie,” I said and lifted up the photo of my late son. “This is Mike, who died after being denied access to care.”

He noticed a microphone on my collar. Robin Carter had placed it there in case she was able to video the encounter. She wasn’t allowed.

“I’m not talking to anyone who’s miked,” he said.

“Well, perhaps you’ll listen,” I answered.

I told him about Mike and about how five to seven people are dying every day in this state because he and his colleagues in the General Assembly have refused to expand Medicaid.

He countered that he tried to talk to President Obama about adding a work requirement, and I told him 70 percent of people who would be eligible for Medicaid work already, and virtually all of the rest are unable to work. I told him how hard a worker my son was, and that he was never looking for a handout, just someone who would be willing to help him stay alive.

“People who need Medicaid aren’t lazy, and they’re not greedy,” I said.

I didn’t add that the people who block access to health care are the takers. I was trying to be calm and polite.

“Well, Medicaid was a mess before I took office,” he said.

Yes it was, because in 2010, the Republicans took over the General Assembly and slashed funding so badly that the Republican secretary of the Department of Health and Human Services resigned rather than preside over such carnage. Before 2010, North Carolina’s Medicaid program was a national model.

But I didn’t have time to tell him that because he had already interrupted me to say he’s expanding access to Medicaid for people with autism.

I told him my benchmark is whether it would have given my son access to care, and adding in a few hundred people wouldn’t have done that. I also told him I don’t think privatizing Medicaid will work any better than privatizing mental health care a decade ago did.

He was happy to talk about the implosion of the state’s mental health system because that was done before he took office. I could see his eyes light up.

“Yes! That system is a mess, and so is treatment for addiction,” he said. “We really need to do something about that.”

But since the majority of people who have addiction don’t respond to treatment the first time, what should we do?

Prevention. That 14-year-old who had surgery probably doesn’t need opiates to deal with his pain, at least not for more than a few days, McCrory said. You give it to him for a month or more and you’ve created another addict.

Of course, this means we can’t have legalization of pot and the windfall of tax money that would come with it, but that’s an issue for another day.

My friends, Robin Carter and Matt Graunke wanted to talk about HB2, but we got the same answers he’s been giving to the media.

“I was on NPR,” he said, as though NPR only interviews reasonable people. He also said the law is about privacy, but when challenged about the privacy of a trans person who only wants to go into a stall and pee, that was different, of course.

He talked about wanting to protect women and both Robin and I said we had been assaulted or abused in places other than rest rooms by people our families knew and trusted, and that since we are adults now, we think women should have been consulted about whether we even think we need protection from trans people in bathrooms.

Frankly, I think we need protection from people like the governor and his friends in the General Assembly, because while they’re distracting us with talk about trans people in bathrooms, innocent people are dying — five to seven people every day, week in and week out, year after year.

When he said he felt sorry about how my son died, my question was whether he would be willing to say that to the 8,000 families of people who have died since he signed the law denying Medicaid expansion. Every one of those families is in just as much pain as mine.

But, hey, after many, many attempts to talk to him, after two arrests for “trespassing” on public property, after being locked out of the state house so he didn’t have to talk to me, I finally got some face time with him.

I only wish I had been able to make him see how his policies are killing innocent people.

At least he didn’t tell me he’s pro-life.

Too little, too late, Governor

Gov. Pat MccCrory waves at the camera after giving my friend, Jamie Sohn, a plate of cookies. I love the look on Jamie's face.

Gov. Pat MccCrory waves at the camera after giving my friend, Jamie Sohn, a plate of cookies. I love the look on Jamie’s face.

North Carolina Gov. Pat McCrory has issued a couple of executive orders this week that I’m sure he thinks will win him back some support.

Unfortunately, it’s far too little and way, way too late.

On Monday, he announced a limited “expansion” of Medicaid services, which would add people with autism, plus increase funding for substance abuse treatment.

He proposed increasing access to Naloxone, which reverses opioid and heroin overdoses, saying he wants to save lives.

Big deal, Governor. There’s still the prickly issue of that half million people with no access to health care, and up to 2,800 of them are estimated to die every year, or up to seven people every single day. Can you tell us why you don’t care about saving those lives?

The governor also said he has met with President Obama about a Medicaid waiver, which would let the state expand Medicaid with its own rules. Those rules would require Medicaid recipients to work to get coverage, and the president rejected that.

Now, the president doesn’t have the power to reject the provision on his own, but he certainly knows what would pass muster with the Center for Medicaid Services, and a work requirement won’t fly.

Thing is, most poor people do work. Many have more than one low-wage job and still live below the poverty level. Many can’t find full-time work because so many companies have stopped hiring full-time employees so they don’t have to offer health benefits. That’s why Medicaid expansion is so important.

The people who are dying are hard working. They’re not lazy, they’re not morally inferior, they’re just poor, and a big part of that is because the GOP has refused to increase the minimum wage to a living wage, which it was meant to be when it was enacted under Franklin Roosevelt.

That brings us to Hate Bill 2.

On Tuesday, the governor issued a video statement announcing he would seek to repeal a portion of the law, which was passed in a single day in a special session, and signed by him as soon as he could get it to his desk.

“I will immediately seek legislation in the upcoming short session to reinstate the right to sue for discrimination in North Carolina state courts,” he said.

But that doesn’t fix the power grab that denies towns and counties the ability to set their own minimum wage, among other things, and it leaves transgender people with no safe place to pee, and still doesn’t protect LGBT people or veterans.

They passed this abomination knowing there would be backlash, and I’m willing to bet they decided before it ever passed which parts of it they would be willing to sacrifice if things got too heated.

Sorry, Governor, but you won’t win back a whole lot of support with these feeble moves, and the lost business and the lost respect won’t be won back, either. You have made this once proud state a laughingstock, and you’re going home in November.

#OneTermPat.

 

Just expand Medicaid already!

Photo by the (Asheville) Citizen-Times There I am, holding Mike's photo, wearing my T-shirt and looking hardass.

Photo by the (Asheville) Citizen-Times
There I am, holding Mike’s photo, wearing my T-shirt and looking hardass.

I never thought I was a radical, but I can feel myself trending in that direction.

I took part in yesterday’s Medicaid Expansion Coalition’s Day of Action, but the action was a spate of press conferences. We were all over Facebook and the evening news. It raised awareness. But no one in the state legislature likely changed their minds about expanding Medicaid.

Dr. Shannon Dowler, medical director of Blue Ridge Community Health Services, was eloquent as she spoke about the people she cares for. It was heartbreaking to hear the stories. I wish legislators had heard her.

This event was not my normal way of approaching Medicaid expansion. I guess it made me realize how my life gave birth to a radical, albeit a nonviolent radical.

I didn’t speak at the event, and I’m glad about that. The event’s organizers know me. I am not one to mince words or speak in approved phrases. Most of the other organizations have programs serving thousands of low-income people. They have a lot to lose. I don’t.

So, I stood behind the speakers, wearing my “Expand Medicaid” T-shirt and holding a photo of my son.

Plenty of words have been spoken over the last two and a half years, and plenty of actions taken. Still, the governor and legislative leaders refuse to expand Medicaid, an action that would allow a half million people access to health care.

People are dying every day. In North Carolina alone, five to seven people die each day from lack of access to health care. The governor signed a law when he first took office that ceded his authority to expand Medicaid to the legislature, and legislators have made it clear they don’t care about these lives.

Perhaps if they had sat next to their dying child, holding his hand as he breathed his last and slipped away, these legislators would have more of a heart for these lives we’re losing.

Instead, they assume it can’t happen to them, that the people who are dying somehow brought their poverty on themselves and deserve their fate. Then they go to church and proclaim themselves “pro-life.”

Since I represent no one but myself here, let me say this:

If you aren’t in favor of saving these precious lives, you are NOT pro-life.

When you say people don’t deserve health care, you lose all credibility with me.

If your support for life ends at the end of the birth canal, you are anti-life.

When you call yourself a follower of Christ and then allow people to die just so you can make a mean-spirited, cynical political statement, you’d better stop and read Matthew 25:31-46.

For those of you who are unfamiliar, this is the passage where Jesus says, “Whatsoever you do unto the least of these, you do also unto me.”

It’s the text where Jesus describes Judgment Day, and it has informed my actions all my life. I’m not perfect at loving everyone. It isn’t always easy helping “the least of these” because their numbers are increasing so fast and their stories are so heartbreaking.

Some of my colleagues, whose life’s work is helping those in need, have to be very careful of what they say and do because they need the funding to continue their work.

I’ve already lost the worst thing anyone can lose; I’ve lost my child. Nothing can be worse than that.

 

 

 

At least I’m not alone

Michael, age 3, playing with his food.

Michael, age 3, playing with his food.

This is a hard time of year for me. Tomorrow is Mike Day, the anniversary of my son’s death.

I think he chose April 1 to go; he was a proud jackass. He loved turning things upside-down and inside-out for a good laugh. His best friend, James, eulogized him as a jackass and everyone laughed and applauded.

I don’t know why this doesn’t get any easier. I honestly thought that after seven ears I would miss him a little less, that the edges would have worn off the pain, but that’s not so. I think of him every day, sometimes every hour, and on days near the anniversary of his death, it’s more like every moment.

At least I’m not alone.

I’m not talking about the friends and family who have stood by me and held me up, although I treasure them; I’m talking about the hundreds of thousands of others whose family members and friends have died the way Mike did.

Before the Affordable Care Act, the death toll was 45,000 a year, and each one was loved by somebody. Each person was adored by friends and family.

The death toll is lower now — about 17,000 a year in states that have refused to expand Medicaid.

Marketing people tell us we need to use the phrase, “close the coverage gap,” but that doesn’t say it any better than “expand Medicaid.”

How about this? It’s time to stop this immoral and inhuman killing of people just because they can’t help enrich insurance companies and Big Pharma.

Or, this for all the “Christians” who think we don;t need to ensure access to care for everyone: Who would Jesus turn away?

And for those of you who are “pro-life,” but think that doesn’t include access to health care: You are most decidedly NOT pro-life, even though you have tried to make the definition only about abortion.

chose not to have an abortion when I was advised to do so, and you “pro-lifers” did nothing to help him get the care he needed after he was born.

You are not pro-life.

Maybe if I was alone, if my son’s case was an aberration, it would be easier.

But my friend, Lila suffers every day because she can’t get insurance. The pain she endures makes it impossible for her to work full-time, and without that income she is eligible for neither premium subsidies nor Medicaid.

My friend, Crystal, is just 30 years old and the mother of two. She has cervical cancer and can’t get treatment because even though she works, she can’t get insurance or Medicaid. She’ll likely die the way my son did, and she will leave behind two orphaned children.

If their lives don’t matter to you, you are not pro-life.

If their lives do matter, you need to do something about it. Our state legislators say the people don’t want to care for the poor because they’re lazy bums.

What they don’t tell you is that 88 percent of people living in poverty have low-wage jobs. And in this so-called economic recovery, most of the jobs being created are low-wage. Fully one-third of people in poverty have two full-time workers in the home and still live below the poverty level.

We need to call and visit our legislators and tell them they’re going home in 2016 if we don;t have expanded Medicaid by then. And then you need to work hard for the candidate who will expand access to health care.

We did it here in Buncombe County. We sent home Tim Moffitt and Nathan Ramsey and replaced them with people who will vote to close the coverage gap, expand Medicaid, stop the senseless and immoral carnage — however you want to phrase it.

My precious son has been gone seven years. I had hoped we would have made more progress by now.

 

The great over-reach and how we can fight it

wrongRepublicans in North Carolina are convinced they will hold power forever, and that it means they should take us all back to Medieval times, where they seem to prefer to live as lords.

First the NC House voted to cut unemployment compensation and make it more difficult to qualify, ensuring more North Carolina families will lose everything when they get laid off. The top weekly compensation will be just $350 a week if this becomes law.

Then the NC Senate voted to reject the expansion of Medicaid, which would bring in nearly $15 billion from the federal government to insure more than a half-million people, including those unemployed people who are about to get royally screwed. Estimates of the number of people who will not gain access to care range as high as 650,000. The Senate also voted to reject partnering with the federal government on a health benefits marketplace, which will cost even more money.

This state ranks 38th in health outcomes (cancer deaths, heart disease, low-birthweight babies, infant mortality, etc.), and we’re about to drop even lower as federal money to reimburse hospitals and other providers gets cut (the expansion of Medicaid was designed to replace this money by covering low-income people with Medicaid).

So now, more than a half-million people in this state are at risk of dying from preventable causes. We will see more advanced cancers, more heart attacks and stroke, more serious complications from diabetes (blindness, kidney failure, limb amputations), more intractable mental illness, more life-threatening, antibiotic resistant infections … And more funerals for people who shouldn’t have died.

It will cost us dearly in both money and human lives.

Now the NC Senate has voted to fire every public servant on several critical boards and commissions to they can be replaced with like-minded ideologues who will rape the environment and offer big business everything it wants. We will see less safe workplaces, more food-borne illnesses, more corruption and much, much less protection of any kind for the people of this state.

The reason the terms on these boards are staggered is to prevent them being stacked with ideologues by corrupt politicians. But a few appointments wasn’t enough for the Teapublicans in  the Senate; they want it all. They want to run everything with no opposition from anyone.

Gov. Pat McCrory, who ran as a moderate, has a chance to veto all of this, but he hasn’t indicated whether he will. He likely will sign the raid on unemployment and he has said he doesn’t think now is the right time to expand Medicaid (When IS the right time, Governor?).

I hope he sees that this power grab is unconscionable.

We need to let our legislators know how important these issues are to us. To e-mail a legislator, it’s firstname.lastname@ncleg.net (example: tim.moffitt@ncleg.net). You can go to www.ncleg.net for more contact information Their phone numbers are listed there. To contact Gov. McCrory, visit http://www.governor.state.nc.us/contact, tweet @PatMcCroryNC, call  919-733-5811 or snail-mail:

Office of the Governor
20301 Mail Service Center
Raleigh, NC 27699-0301

Do it now and then do it every day until the issues are resolved. If these things go through, e-mail every day to let them know they’re going to be unemployed in 2014 (or in the governor’s case, 2016).

 

Let them know you care

The mindset of the American Tea Party.

The mindset of the American Tea Party.

The Tea Party-infused North Carolina General Assembly lost no time on the opening day of the legislative session letting us all know just how far-right they are.

Without consulting the new governor, who also is a Republican, they voted to go back on the decision by the previous governor to form a partnership with the federal government to build our health benefits exchange (the marketplace where people will buy insurance starting next year). They also voted to reject the Medicaid expansion, even though the state will pay nothing for the first three years and then just 10 percent thereafter.

North Carolina has 500,000 people who would benefit from the expansion and who otherwise will have no access to health care. Some will die.

Not that NC legislators care.

Fortunately, this decision is not up to them; it is up to Gov. Pat McCrory.

Which leaves us a little hope since he has not announced his decision yet.

So, we have to move quickly. Here’s what you can do. Visit http://www.governor.state.nc.us/contact and e-mail or call the governor to let him know you take this issue seriously.

The lives of a half-million people could be at risk if McCrory decides against expanding Medicaid to everyone whose income falls below 133 percent of the federal poverty level.

What’s worse is that move is financially foolish. The federal government will foot the entire bill for the first three years and 90 percent thereafter. Compare that to the cost of more heart attacks, more strokes, more amputations, more kidney failure, more asthma, more advanced cancers and more intractable psychiatric illnesses among these 500,000 people.

There’s no compassion in the decision not to expand Medicaid, just a backward ideology.

Please let the governor know we need to expand Medicaid. If he hears from enough of us, he might listen.

 

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