Affordable Care Act Funds Coming to Carrboro

Primary care services in Carrboro are getting a boost from the Affordable Care Act.

The Carrboro Community Health Center will receive more than $270,000 in funds from the Affordable Care Act to improve primary health care services, according to Jason deBruyn with the Triangle Business Journal.

“One of the big drivers of health care costs, in the United States, is that people just simply don’t take advantage of primary care,” he says. “The primary care physicians don’t have enough control over treatment of patients at sort of a basic level.

“And that leads to all kinds of downstream problems – chronic illnesses, people showing up in the emergency rooms, having expensive surgeries – when maybe they could have managed their diseases much better.”

deBruyn says this money will turn into supplies needed at the facility or for community outreach programs.

“You could have health clinics where you go out to churches or community centers and help educate people on proper eating,” he says. “Or have people in the community centers encouraging patients to come in for health checkups.

“Or even put in health-screening day, where you tell people ‘come on in for free, and we’ll screen you for your health.’”

deBruyn adds routine primary care health checkups are a vital factor in lowering health care costs and maintaining higher levels of health across our community.

“Health systems, hospitals, doctors, it’s something they’ve been trying to do a much better job of here lately,” he says, “getting people in for those routine checkups.

“Just like you would getting your oil changed in your car. It’s maybe a bit of a crass example but not that dissimilar.”

These funds are a piece of the most recent distribution from the Health Resources and Services Administration, according to deBruyn. He says the funds in the Tar Heel state total nearly $4 million, which will translate to serve more than 20,000 new patients in North Carolina alone.

The Carrboro Community Health Center is part of the Piedmont Health Services network.

Other recipients in North Carolina, according to deBruyn, are the Appalachian District Health Department in Sparta, Blue Ridge Community Health Services in Hendersonville, Rural Health Group in Roanoke Rapids, and Triad Adult and Pediatric Medicine in Greensboro.

SCOTUS Keeps Affordable Care Act Subsidies

***UPDATE: The Supreme Court has issued a 6-3 ruling allowing subsidies to continue to be offered in states that did not establish their own marketplace. You can read the full opinion here.***

The U.S. Supreme Court will release a decision within the next few days that may affect more than half a million North Carolinians who purchased health insurance through the Affordable Care Act.

The question before the Court in King v. Burwell is whether the federal government overreached when it allowed subsidies to flow to states, like North Carolina, that did not set up their own health insurance exchanges.

North Carolina is among 34 states that do not have state-run health insurance marketplaces. That means North Carolina residents who want to buy insurance through the Affordable Care Act have to do so through the federally-run exchange. About 550,000 North Carolinians did just that, and most of them, says Duke University public policy professor Don Taylor, received tax breaks to help pay for their premiums.

“Ninety-one percent of the North Carolinians have gotten a subsidy,” Taylor said,  “and the average amount of that subsidy is about $315 a month.”

The plaintiffs in the case argue the Affordable Care Act does not allow the federal government to give those subsidies to people in states that don’t have a state-run exchange.

“So if the Supreme Court had a simple finding for the plaintiffs,” Taylor said, “then the tax credits that are coming to North Carolinians today, they would lose those tax credits, their insurance bills would then go up, and then presumably many of them would them drop their coverage.”

Taylor says not only would such a ruling affect those who dropped their coverage because they couldn’t afford the premium, it could topple the entire federally-run exchange:

“The problem is the people who wouldn’t drop coverage, the people who are desperate to keep their insurance, are probably people who are sick. And any type of insurance market—whether it’s car insurance, homeowner’s or health insurance—if the healthy people flow out because the premiums go up, and you only have sick people left, then that’s called ‘death-spiral,’ and that insurance market is unsustainable.”

If the Court does rule for the plaintiff, Taylor says depending on the details of the ruling, there could be some legislative fixes at the national and the state levels to keep the tax breaks coming.

“Maybe North Carolina could pass a simple law that says we desire for the subsidies to still flow in North Carolina. But then it’s back to a political question again.”

The Supreme Court is expected to release a decision by Monday, June 29.

UNC Hospitals Face Medicare Penalties

UNC Hospitals may have to pay millions in Medicare penalties for a high number of patient infections and complications, according to a provision of the new health care law.

In an effort to lower health costs, the Affordable Care Act has authorized Medicare to make assessments of hospital-acquired conditions, and crack down on hospitals that aren’t meeting their standard.

Preliminary scores show 16 N.C. hospitals are currently at risk of penalties, including two of the largest in the Triangle: UNC Hospitals and WakeMed in Raleigh.

Medicare authorities score on a ten-point scale, with the worst of the infections and health complications of hospitals ranking higher. UNC Hospitals was scored at 7.375; WakeMed received a score of 8.025.

All scores above 7 fall below the 25th percentile.

“Medicare is comparing all hospitals across the country, but it isn’t making any adjustments or consideration for how sick the patients are to begin with. So if one hospital takes more sicker patients than another, it’s reasonable to think that there may be, in the aggregate, more infections. But that may not have anything to do with the quality of care that’s provided in the hospital.”

That’s Brian Goldstein, executive vice president and chief operating officer at UNC Hospitals on why its 801-bed facility ranks higher than most in hospital-acquired conditions.

Goldstein says the scores are self-reported and submitted to Medicare by UNC Hospitals, and rankings are calculated solely through assessments of Medicare billing, and monitoring hospitals for infections.

Hospitals were notified of their scores in April, allowing for administration to review their rankings before the final scores and penalties are released in the fall and administered in the 2015 fiscal year.

The scoring system has no minimum passing grade, leaving hospitals that do not receive a performance requirement score less than 7 with definite penalizations, and a 1 percent cut in Medicare reimbursements.

The program does not recognize any patient care documentation or factors outside of their final tally of infections, such as how sick the patients are upon admittance, or the socioeconomic backgrounds of hospital patients.

“Twenty-five percent of hospitals are going to get penalized through this program, no matter how much they improve,” Goldstein said. “The actual scoring is based on how the hospital compares to itself from a baseline period of 2006 or 2007. That’s how Medicare chose to score this so, let’s say, you’re a hospital that wasn’t doing so well in 2006 and 2007, but now you’re doing better. You’re going to get a better score. Now, let’s say you were already doing well (at that time) and you didn’t improve as much and your infection rates might even be lower than the other hospital but you’re still going to get a worse score in this program.”

Goldstein compares this system to a teacher “grading on a curve”, and announcing on the first day of school that 25 percent of students will automatically fail, no matter how well they do throughout the course – just because that is class policy.

The penalties provided by the Affordable Care Act have been a controversial hot topic in the hospital industry, as many of the largest and more research-based hospitals treat the sickest patients, putting them at a higher risk of infections and other common complications.

Goldstein told WCHL the Association of American Medical Colleges recently wrote to the Centers for Medicare and Medicaid Services to alter their scoring system for a more holistic reflection of the quality of a hospital’s care.

With final scores soon to be released, Goldstein says he believes it’s important for the Medicare system to be reformed, but also for hospitals across the nation to keep their focus on the health and safety of their patients.

“We could go a lot deeper and wider in discussing all of the efforts we make everyday to aggressively find and fix problems that could lead to safety issues and quality. That all needs to continue, but all we’re asking for is for these programs that tie back to dollars to be based on a fair assessment of the data that all hospitals provide.”

Post Health Care Deadline, Officials Say More Than 7 Million Enrolled

As the March 31st deadline for Americans to enroll in health care has come and gone, early estimates indicate that more than 7 million Americans successfully signed up for coverage, despite problems and long wait times.

Sherry Hay, UNC Family Medicine Director of Community Health Initiatives, says her department and community partners have been working to help locals sign up for health care since open enrollment under the Affordable Care Act began on October 1 of last year.

On Monday, Hay says UNC Family Medicine was still taking calls and answering people’s questions about enrolling for health care.

“Through the month of March, we tried to do a variety of events— some more global type of community events with other partners such as UNC General Internal Medicine and others in the community, to scheduling patients around their medical appointments here at family medicine to see a certified application counselor,” Hay says.

The last-minute rush before Monday’s midnight deadline was a headache for some, as people reported call wait times of more than two hours and constant glitches with the website. Such problems have plagued the system since its debut.

“During these tight times when we are all dependent on the system, it is really frustrating, and people were frustrated by that when it didn’t operate as it should,” Hay says.

Still, federal officials estimated that about 2 million Americans were able to successfully enroll in the two weeks leading up to the deadline.

According to data released in February, Hay says it was estimated that more than 200,000 North Carolinians had enrolled through the federal health care exchanges.

In 2013, 1.5 million people in North Carolina were uninsured.

“It has been an interesting change in healthcare, one of the biggest in decades. There was no state agency that was necessarily deemed the agency to be responsible for the change,” Hay says.

All people, with few exceptions, are required to have health insurance. People who are already covered by health insurance through a private provider are not required to change coverage.

Citizens who can afford health insurance but did not purchase it by the March 31 deadline will be fined $95.

However, the enrollment period has been extended for those who began the application but were unable to finish.

“The Obama Administration did release that if someone had started the process by midnight [on March 31st], they will have until April 15th to complete the application process,” she says.

Now that this open enrollment period has ended, Hay says UNC Family Medicine and its partners will regroup, assess what went well and what didn’t in helping to get people signed up and focus on the next open enrollment, which begins in November and runs through February of 2015.

Health, Safety, Schools, Libraries, And Hillsborough

If you still haven’t signed up for health insurance, the Chapel Hill Public Library is holding an all-day Affordable Care Act enrollment session on Monday, March 24, from 10:00 a.m. to 8:00 p.m.

The library is holding the session in partnership with UNC Healthcare, the League of Women Voters, Planned Parenthood, and UNC’s Student Health Action Coalition.

The deadline to sign up for health insurance in 2014 is March 31.

For more information or to reserve a time, call the Chapel Hill Public Library at 919-968-2780.


Are you a veteran or connected to the military? Orange County’s Department of Social Services is inviting you to a new event called “Military Monday,” geared especially toward veterans to make sure they have access to benefits and other federal, state, and local resources.

The first Military Monday event will take place on March 24, from 9:00 a.m. to noon at Hillsborough Commons on Mayo Street. It will be a Career/Resource Fair, with benefit assistance, career assessments, education resources, the Mobile Vet Center and more.

For more information, contact Betsy Corbett at 919-245-2890.


Hillsborough Mayor Tom Stevens will deliver his annual State of the Town address on Monday, March 24, at 7:00 p.m. in the Orange County Public Library.

Among other things, the address will include an update on the town’s Riverwalk project as well as a discussion of Hillsborough’s future population boom. The town is expected to grow by 31 percent in the next four years.

Members of the public are invited to attend. Before the speech, from 5:30-6:30, planning staff will host a public information meeting on the status of downtown access improvements.


If you’re a parent in the Chapel Hill-Carrboro City Schools and you’d like more information on the district’s dual language program, the district is offering four information sessions this spring, beginning later this month and running through May.

The Dual Language program gives students the chance to become proficient in two languages, English and either Spanish or Mandarin Chinese. The district says Dual Language students, on average, outperform their peers on standardized tests and other student growth measures.

The first information session will be for the Spanish program on Thursday, March 20, at Frank Porter Graham Elementary School. The session will be offered in Spanish from 6-7 p.m. and in English from 7-8 p.m. Two more sessions on the Spanish program will take place—at the same times of day—on Thursday, April 24 at Carrboro Elementary and on Thursday, May 22, again at FPG.

There will also be an info session on the Mandarin Chinese program on Tuesday, March 25, from 6-7 p.m. at Glenwood Elementary.


Are you excited about the proposed new Southern Branch Library in Carrboro? What do you want to see there? What do you NOT want to see there?

If you have thoughts and ideas about the library, come out to a Community Engagement Meeting hosted by Orange County. The county is actually holding two meetings: the first is Tuesday, March 25, at 6:00 at Hickory Tavern; the second is on Saturday, April 12, at noon in Carrboro Town Hall. The first 50 participants at the March 25 meeting will receive gift certificates to Hickory Tavern.


The Hillsborough Arts Council has announced a partnership with a new charter school coming to Hillsborough this August.

The Expedition School will be taking part in the Art Council’s ArtCycle program, a program that collects new and used art supplies to be used in local schools.

The Expedition School is scheduled to open its doors in August. It’s a STEM-focused school for grades K-8.


Driving around this month, you might see some new signs on the road – all part of a local campaign to remind people to pull over if they see emergency vehicles coming their way.

The campaign is called “See the Light, Pull to the Right.” The idea came from a town employee, Fire Equipment Operator Luis Rodrigues. Six new signs are being installed near major intersections in Chapel Hill.

If an emergency vehicle is approaching you from behind, take your foot off the accelerator, merge to the outside lane if possible, and pull off the side of the road to allow the vehicle to pass.


Gender May Be Key To ACA Impact On Small Biz

How is the Affordable Care Act affecting small business owners in the Chapel Hill-Carrboro area?

The answer may depend on the gender of the workers they employ.

That, at least, is the tentative finding of a survey of local business owners conducted by the Chapel Hill-Carrboro Chamber of Commerce.

When asked how the Affordable Care Act was impacting them, 30.5 percent responded “negatively” or “very negatively,” while 23.9 percent responded “positively” or “very positively.” (The rest—not quite half—were either unaffected or unsure.)

But Chamber president Aaron Nelson says a closer look at the responses reveals something interesting.

“Some of that is about the neutralizing of men and women, (who) cost differently in the old world and cost the same now,” he says. “So if you had a predominantly younger female staff, your rates likely go down – (but) with a predominantly male staff…your rates could go up. So gender has had a real impact on cost.”

Nelson says auto body shops, in particular, have reported their health care costs going up—while the Chamber itself, with a mostly-female staff, has seen its costs decline.

Chamber economic briefing ACA slide

Additional results from the survey are available at (also the source of this image). As seen here, there’s only a slight lean towards the ACA having a “negative” effect if severity is not taken into account, but that changes if severity is considered: a far greater percentage of respondents reported a “very negative” effect than a “very positive” effect.

Nelson presented the results of the survey at last week’s annual Economic Outlook Briefing at the Sheraton Chapel Hill.

PPP: Obama’s Approval Rating Remains Low

RALEIGH – A poll released Tuesday by Public Policy Polling shows the president’s approval rating stalled at his lowest point.

That’s because his biggest domestic policy achievement continues to hold his numbers down.

The Affordable Care Act remains unpopular with most voters surveyed by PPP, and Democrats everywhere are taking the hit.

Tom Jensen, director of Raleigh-based Public Policy Polling, breaks it down.

“We continue to find Barack Obama with some of the lowest numbers he’s had since taking office,” says Jensen. “Only 41 percent of voters approve of the job he’s doing nationally. Fifty-three percent disapprove.”

That 41 percent mark, for the second month in a row, matches the lowest number for the president in the PPP survey.

The numbers for Democrats, in general, are sinking. Republicans now have a slight lead in a generic congressional ballot, 42-to-40. That’s a seven-point shift from the height of the government shutdown in October.

The Affordable Care Act appears to be the biggest drag on their approval rating. Only 38 percent of voters like the ACA, with 52 percent opposed. Only 32 percent think it’s been implemented successfully, while 62 percent do not.

But Jensen says that two issues may signal a bright side for Democrats.

“We find that a couple of the things that Barack Obama might emphasize this year are really quite popular,” says Jensen. “When it comes to extending unemployment benefits, 63 percent of voters think they should be extended. Only 32 percent think they should be cut off.”

Plus, the Democrats have the upper hand when it comes to raising the minimum wage to $10 per hour.

“Fifty-five percent of voters support that,” says Jensen. “Only 36 percent are opposed.”

With that in mind, Jensen says the president should try to take the focus off Obamacare, if he’d like to see his numbers improve.

“He needs to find some issues where he can get some support across party lines,” says Jensen.

Federal Data Show Health Disparities Among States

JEFFERSON CITY — The slow rollout of a new federal health insurance marketplace may be deepening differences in health coverage among Americans.

New federal figures show more people are gaining coverage in states that have fully embraced the federal health care law than in those whose elected officials have rejected involvement.

In the dozen states that expanded Medicaid eligibility and are running their own health insurance exchanges, about half the people who applied for coverage through the exchanges have either picked an insurance plan or been routed to Medicaid.

The percentage of applicants selecting an insurance plan or being directed to Medicaid barely tops 15 percent in the two dozen states that have rejected Medicaid expansion and relied solely on the federal government to run their online insurance marketplace.

BCBSNC To Extend Some Cancelled Health Care Plans

CHAPEL HILL- Blue Cross Blue Shield of North Carolina announced Friday that it will work with the N.C. Department of Insurance to allow some consumers to retain enrollment in health care plans previously slated for termination.

The plans identified for cancellation do not meet the standards for insurance under the Affordable Care Act, but President Barack Obama on Thursday announced a policy change that would allow insurers to offer the plans for another year.

The N.C. Department of Insurance will review and approve the rates for the extended policies. Brad Wilson, President and CEO of Blue Cross Blue Shield, said more information should be available to customers at the beginning of December.

Statewide, more than 473,000 residents have received notice that their plans will be terminated. Insurance Commissioner Wayne Goodwin said his staff is working to help all affected policyholders take advantage of the extension.

Sen. Hagan Approval Slipping in Wake of Obamacare Web Launch

Raleigh – The failed launch of the Obamacare website is acting like gravity for the approval ratings of democrats in Washington D.C.

***Listen to the Story***

Senator Kay Hagan’s approval ratings are changing, but Public Policy Polling Analyst Jim Williams says they’re not going the direction the Hagan administration would prefer.

“We had found Kay Hagan with a small, but consistent lead throughout most of this year,” Williams says, “We’re finding now that it’s really kind of crept into a statistical tie at this point.”

The poll shows Hagan in a dead heat with her prospective 2014 opponents; coming in no more than three points ahead of state House Speaker Tom Tillis, Heather Grant, and Rev. Mark Harris. And she’s trailing one point behind Greg Brannon.

So what’s the force behind the trend?

“That stems probably from the botched roll out of the Obamacare website,” says Williams.

The website has been a nightmare for the faces of the Democratic Party since opened its marketplace for federal health insurance on October 1.

“Obama’s approval rating in September was 48 percent approve, 29 percent disapprove,” Williams says, “Now it’s down to 43 percent approve, 53 percent disapprove.”

Williams says North Carolinians have responded negatively to the health care plan they were already skeptical of in the first place.

“Obamacare has never been particularly popular in North Carolina, but now only 38 percent of voters say they approve of it, compared to 48 percent who disapprove,” Williams says.

“Even worse 69 percent of voters say its rollout has been unsuccessful so far.”

The 2014 senate election is still a year away. Williams says there’s a large group of undecided voters who could come to Hagan’s rescue.

“The race is sort of unformed as far as the senate race,” Williams says, “A lot of the folks who either are running or may run are not well-known to the voters yet; so that’s why you’re seeing high numbers of undecided voters.”

Senator Hagan originally supported the Affordable Care Act. But she announced Tuesday that she is asking for an investigation of the failed website launch.