Stakes are high in healthcare conversation

Jun. 13--A January 2019 study by the Pew Research Center shows that healthcare is the top issue for 69 percent of those polled.

The Haywood County Democratic Party's second "myth-busting" forum was on that very topic, and drew about 65 to a Tuesday meeting held at the USDA service center in Waynesville.

Panelists included Steve Davis with General Insurance Services, who talked about the industry changes through the years; Silver Bluff Village's Lisa Leatherwood, who discussed the plight of the elderly as Medicaid changes near and Sheriff Greg Christopher, who spoke about how the community would be changed if there were adequate mental health treatment centers.

Dr. Stephen Wall moderated the program.

Davis spoke of the superior insurance coverage now available to consumers, thanks to the Affordable Care Act, often called Obamacare. While many more people now have insurance under the act, the downside, he admitted, has been to price those who don't qualify for subsidies out of the market.

The solution is a simple one, however, and that is to make everyone pay something to be covered.

"Things got messed up along the way when they took away the mandate," Davis said. "Insurance is community pooling. That's what makes it work."

Still, the 11 essential coverage areas now required under the federal act offer policies that are in the best interest of consumers, he said, recalling the day when only some hospital costs were covered, and that maternity coverage was a separate add-on that couldn't be bought once a consumer knew about a pregnancy.

Mental health wasn't covered, nor were some outpatient services, Davis said, and years ago, lab services required a separate policy.

"I've been in the insurance business for 51 years, and have been an eyewitness to what's happened," he said. "With absolute certainty I can say the ACA created by far the best health insurance product ever put on the market. It's still hanging on by its teeth, and you better hope and pray it doesn't go away."

The act also made it possible for those with pre-existing conditions to get coverage, as well as for college students to remain on their parents' policy, both major accomplishments, Davis said.

Leatherwood agreed that buy-in from all would create a larger pool that could reduce prices.

"I don't understand the logic of not being forced to have health insurance," she said. "If you drive a car, you are forced to have insurance. If you breathe, you should have health insurance."

Elderly on the streets?

In North Carolina, Medicaid covers 66 percent of the long-term care costs for skilled nursing services, Leatherwood said, but at a reimbursement rate of $65,459 annually, which is a long way from the $82,000 it costs.

Under the current ACA policies, North Carolina long-term care facilities receive an additional $15 a day for Medicaid patients, an amount that would go away if the act is repealed.

"Our margin is 1 to 2 percent. If the ACA goes out, nursing homes won't survive," she said. "We can't afford cuts to Medicaid nor huge cuts to Medicare. The big piece is not realizing all the things attached to ACA."

Leatherwood spoke of a managed care system approved by the legislature whereby five insurance companies, three of which are out-of-state, will be given all available Medicaid dollars to provide care for patients in a defined area of the state.

Leatherwood didn't mince words about the transition. It comes down to paying another insurance company to decrease spending, an action that will ultimately compromise care.

"Where will (the savings) come from? Out of services, and we know that," she said, predicting services to the home-based and young would go first, adults next, and skilled nursing care last.

"We don't know how bad it will impact us, but in other states that have tried this, administrative costs have gone up and services have been cut," she said.

Leatherwood said there are 650 residents in Haywood County who are in skilled care facilities and are on Medicaid.

"My cost is $190 a day, bare minimum," she said. "Nobody can afford it. And the fact is, now Medicaid pays so little it's not enough money for staffing. When cuts happen, most people cut staffing. My average age is 90. They need a lot of care."

Mental health help

Christopher cited cases whereby states that expanded Medicaid coverage were able to give hundreds of thousands of their residents access to addiction and mental health treatment options.

Currently there is one inpatient addiction treatment center in Haywood -- the Balsam Center -- the behavioral health unit at the hospital and several outpatient options.

In Ohio, however, there are dozens of new treatment facilities, residential programs and outpatient clinics to address the opioid addiction problem that has swept the nation.

"If you are a state without Medicaid expansion, you can't build a system for helping this disease," he said.

The epidemic is fierce in Haywood County. While insurance helps pay for treatment, Christopher surveyed the 115 individuals currently in jail and found only 26 had insurance. Statistically, 85 percent of those in jail are there for mental health or addiction problems, he said.

In 2018, law enforcement officers served 647 in-county involuntary commitment orders to people who didn't think they needed help, he said, estimating there were probably twice that number who sought help a voluntary basis.

He cited statistics from a 2016 behavioral health evaluation project showing that most inmates had one or more behavioral health condition, and that access to services could drastically reduce recidivism rates.

Treating addiction for those processed into the jail is costly for taxpayers, Christopher said, but it was also wasteful since none continued on the treatment plan designed in jail as they didn't have the financial resources to do so.

"Most of the time, if inmates do not take on a full time role in trying to beat opioid addiction, they won't beat it," he said. "They have got to go to a long term facility and get intensive rehabilitation. There's a grip that an opioid has on you that is like nothing else as described by many doctors. We see few who are able to beat this in an outpatient clinic."

Expand Medicaid

Panelists agreed that many of the problems they have been seeing could be reduced if North Carolina joined the majority of other states in the nation and expanded the income guidelines for Medicaid eligibility. Doing so would provide more employment, offer a way for residents to get the health services they need, and actually reduce costs to the state.

"The Affordable Care Act covers 4,000 in in Haywood County, 5,050 children are on Medicaid, an unknown number is on Social Security disability and 15,000 are on Medicare. These could be lost after 2020," Wall said. "The threat is we'll deal with healthcare after the election. AARP tells us that $1.5 trillion in Medicaid and an $850,000 million cut in Medicare are at stake. That means we will be spending $1.4 trillion less at a time when the population is aging. We must make sure this doesn't happen."

Will healthcare be the Achilles heel for Republicans?

"Perhaps," Wall said. "It affects 75 percent of people in Haywood. Take these points you heard about and begin to talk with neighbors about programs that are at risk."

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