ObamaCare restricts how states can save money on Medicaid
until they take on larger burdens they
can’t afford in 2014. North Carolina has a $3.2 billion spending overhang
going into the 2011-2012 budget year, with $800 millon of that a result of
one-time money from the federal government.

The Patient Protection and Affordable Care Act (PPACA)
forbids tighter eligibility standards except to "nonpregnant, nondisabled
adults" with incomes over 133 percent of poverty, which applies to exactly
zero people on North Carolina Medicaid.

With no option to reduce eligibility, the way Medicaid
currently works, states must either eliminate optional services or reduce
payments to doctors. The former likely won’t save enough, unless the state also
eliminates prescription drug coverage. The latter may also be limited by
federal requirements on maintaining access. Doctors are already dropping out of
Medicare and Medicaid because of low payments from the government insurers.
Further reductions in Medicaid reimbursement will only worsen the problem.

That is why I have advocated seeking a waiver to transform
Medicaid into a premium support program to aid in the purchase of private
insurance and fund personal acounts. As Nebraska
Sen. Ben Nelson wrote, "[P]rivate insurance generally is better than
Medicaid." If the state can reduce cost and provide better health care
coverage to the poor, the premium support and personal account plan should be a
no-brainer and get federal approval for a waiver.

***

Insurance exchanges
North Carolina has received $1 million to set up a health
insurance exchange in 2014 and is committed to setting one up. But John R.
Graham says the exchanges
are a bad idea.

Less HSA freedom
Stock up on over-the-counter medications with your Health
Savings Account (HSA) before January 1 or you
will need a doctor’s prescription for your Advil, Prilosec, Claritin, or
Children’s Tylenol.

ObamaCare and Employers
Hadley Heath at the Independent Women’s Forum explains the effects of ObamaCare for
small employers. They ain’t good.

Certificate of Need update
In a recent newsletter, I wrote about the Certificate
of Need (CON) process in North Carolina. In Hoke County, where civilian and
military personnel will move with the expansion of Fort Bragg, construction of
two hospitals may be delayed for years as health systems fight to become the
sole hospital owner in the county, reports the
Fayetteville Observer.

"I don’t like it," said
Stephanie Overby, a county resident and co-owner of Friendly Reminders Inc., a
printing shop in Raeford. "There is no hospital here at all, and the
people in this county have to suffer for it. There is nothing."