>>This is the final installment of a month-long >>series on how the Affordable Care Act, commonly known as Obamacare, benefits women and what you need to know if you do not have your insurance or lose your insurance to get coverage through it. This week we are profiling a woman leader who is making an impact in North Carolina on healthcare issues, including Obamacare.
“I’ve always had these three tracks in my life,” explains Robin Lane of Greensboro. She’s a nurse who has worked both in public health and in private practice. She’s also been an educator of nurses, and currently serves as a preceptor for nursing students finishing up their master’s degrees.
“Because those first two [tracks, as a nurse and an educator] informed my understanding of the need for change in our healthcare system, I became an advocate.”
Lane is one of the women leading the effort to educate North Carolinians about the Affordable Care Act (ACA)– what it means for people of all ages and for the health care system, and how the decisions of North Carolina’s leaders will affect the law’s implementation.
The Connection between Policy and Health
As a public health nurse, Lane is concerned with how to care for and improve the health of communities, not just individuals. During her time working in Grenada in the West Indies, and in low-income communities in the United States, she saw the impact – positive or negative – that public policy could have on the well-being of entire populations of people.
“What’s apparent to you if you work in a place like the South Bronx is that the way a community cares for its people and its political decisions and policy decisions really impact health in very important ways,” Lane said. “For example, poor housing and violence cause stress for children and compromise their mental well-being and perhaps even their growth and development. They can’t achieve their full potential if the community hasn’t cared for them. Sometimes parents are able to garner all of the resources that are needed, but many times that’s not the case, particularly in lower-income communities. The whole village, so to speak, needs to come and bring resources to bear on common problems.”
It was her passion for public health that prompted a friend to invite her to get involved with the League of Women Voters in Greensboro. For many years, while her children were still young, she couldn’t become deeply involved in the League’s efforts. But today her children are in their 30s, and she has dedicated herself to promoting smart health policy and the importance of the Affordable Care Act.
For Lane and other healthcare advocates, the decision by the NC General Assembly and Governor McCrory to reject Medicaid expansion was a disheartening blow, but it was also a catalyst. They ramped up their community education efforts to teach people about health reform, dispel myths, and encourage North Carolinians to speak up to their elected leaders.
Different Audiences, Different Questions
Lane does 20 to 30 presentations a year to a variety of groups – churches, medical providers, community organizations, students of public health or law.
She gets very different questions from older audiences than from younger audiences.
“If you’re talking to senior groups, they always want to know whether or not this going to limit access to providers,” she said. “Access to providers is an old issue.” She has to explain to her audience that the lack of Medicare providers, which is primarily due to Congress’s decisions to cuts reimbursements rates, is entirely separate from the Affordable Care Act, and that ACA implementation could result in more providers accepting Medicare.
Then she focuses their attention on all of the benefits seniors are already receiving from the ACA.
“What they are getting from the Affordable Care Act should contribute to their health significantly. For example, the Affordable Care Act has a ‘Welcome to Medicare’ visit, where the senior sits down with their physician and the physician is paid for the time he spends to gather a complete medical family history so he can prioritize their healthcare needs.” Lane explains that such conversations are essential for good care, but they can be time-consuming and, before the ACA, Medicare wouldn’t pay for them. Now Medicare will cover both the welcome visit and annual wellness visits.
“The younger people just want to avoid the whole conversation all together,” Lane said. “What they’re really concerned about is whether or not their employment will be secure.” So she explains to them that rising healthcare costs are part of the reason why wages for working Americans haven’t kept up with the cost of living.
“American wages have remained flat to some extent because any increase in [a business’s] net profits went to the increased cost of premiums. So wages were flat, and at the same time workers were asked to shoulder more and more of the burden. It’s an unsustainable, heading-towards-the-cliff kind of system, which I think most Americans are not willing to face.”
She finds that with young audiences, she has to combat a great deal of skepticism about government in general and the ACA in particular.
“I try to upbeat and tell them the things the Affordable Care Act has done for them. That people did recognize the need for kids to be insured through their school years so they could get a good education for their best employment opportunities. Keeping them on their parents’ insurance through age 26 – that group of uninsured has had the biggest drop of all.”
Lane also makes sure to explain to young people the most important and tangible benefit of the Affordable Care Act – the health insurance exchange, which opens in October. Through that online marketplace, millions of Americans will be able to compare the benefits and costs of various insurance plans, and they will fill out one application to apply for coverage and see if they qualify for subsidies.
“It’s hard to imagine when you’re young and healthy, but at some point you or a parent or a sibling or a friend will really appreciate that they can go to a marketplace – just like you book a ticket on Orbitz.”
The Healthcare Battle in North Carolina
North Carolinians will have to use the federal health insurance exchange when it opens in October, because the NC General Assembly and Governor McCrory passed a law saying the state would not set up its own exchange.
That same law also rejects Medicaid expansion under the Affordable Care Act. In North Carolina, that expansion would have provided health coverage to approximately 500,000 people.
“Physicians and nurse practitioners and other providers have an idea about what will help the people in their care, and it’s very disheartening to not be able to get that care to that patient because they don’t have any means of paying for it,” Lane said. “If we want to get people insured, which is one of the goals of the League and certainly one of the goals I have as a provider, the quickest and best way to do that is through Medicaid expansion.”
The rejection of Medicaid expansion is especially problematic for rural hospitals, which see a disproportionately high share of uninsured patients. Currently, those hospitals get supplemental funds from the federal government to help pay for the care of uninsured patients. But under the ACA those federal funds disappear because those patients were supposed to be covered under Medicaid. North Carolina’s leaders’ decision to reject Medicaid expansion leaves rural hospitals with thousands of poor, uninsured patients and no way to pay for their care.
Lane says that leaves rural hospitals will few options. “The consolidation of health systems… for economies of scale, which everyone agrees is a positive for the bottom-line budget analysis – that can’t happen for rural hospitals. So there’s going to be greater disparities between the huge urban medical centers and the rural ones. Whether or not other systems will come and take over those rural hospitals in a way that rural communities will find palatable remains to be seen. But there are large areas of the state where people will have to travel to get their health care, either by ambulance or by private car for primary care.”
She believes people in North Carolina don’t yet understand how state lawmakers’ decision to reject Medicaid expansion will affect them, but that they soon will.
“This next go-around people are going to connect the dots. Before we didn’t have a vote by Senator Berger or Speaker Tillis, but now we’ve got that on the record. And people are going to be able to ask them, ‘You know, my aunt died because she didn’t have health insurance. Are you okay with this?’ I don’t think they’re going to be able to continue their heads-in-the-sand approach for very long. Right now, they believe they are representing their constituents. But I don’t think their constituents were able to imagine all the harm that was going to come to them.”