The People’s Grand JuryMarch 2, 2015

Charles van der Horst, MD, FACPProfessor of Medicine

University of North Carolina at Chapel Hill

Why the Affordable Care Act was Implemented: Economic

How the US stacks up compared to the world

The Uninsured in North Carolina are your neighbors

Constructioncarpenters brick masons

roofers

Food Service

fast food workers

cooks waitresses

Salescashiers retail

salespeople street vendors

Cleaning and Maintenance

housekeepersjanitors

landscapers

Productiontextile operators laundry workers

tailorsTransportation

bus drivers taxi

drivers parking attendants

Office and Administrativehotel clerks Supportoffice

clerks messengers barbers

child care workers personal care aides

56K

59K

46K

43K

36K

34K

32K

18K

Personal Care and Support

Health Care Support

home health aides nursing aides dental

assistants

All Other

0 20 40 60 80

Note: People are classified according to the job theynow have or the last job they held in the prior 12 months.

16K

66K

Top 9 Professions of Working Uninsured North Carolinians 2014Families USA

Lack of Health Insurance Decreases Preventive Care (increasing unnecessary and expensive hospital admissions):

What the Affordable Care Act did:No pre-existing conditionsNo life-time cap on costsPortabilityFree preventive care and immunizationsInsurance for 30 million uninsuredParity of mental illnesses with medical illnessesDecreasing growth in medical expensesHospitals decrease readmission + infectionsTrain more primary care doctorsRestricts insurance administrative costsFills Medicare donut hole

Our Hope: Improve quality of care

Health Insurance and Mortality:

Where Poor and Uninsured Americans Live

Adjusted Hazards forMortality among US Adults 17-64 years:NHANES III 1988-2000

Wilper et al AJPH 2009

Smith et al J Surgical Research 2013

Lack of Health Insurance increases cancer deaths

Sommers NEJM 2012

1997-2007

Cost to Kentucky: $74 million in 2017 rising to $363 Million in 2021Benefit to Ky (2014): Medicaid Revenue to Health Care Providers $1.1 billion 388,000 insured, 12,000 new jobs (avg salary $41,000)

DeLeire et al Impact of Insurance Expansion on Hospital Uncompensated Care Costs in 2014September 24, 2014 Office of Ass’t Secretary for Planning and Evaluation US HHS

North Carolina State-level Losses in Federal Funding, Employment, Economic Activity and Tax Revenue Because North Carolina Did Not Expand

Medicaid in 2014 (Compared to Levels If Medicaid Had Been Expanded)

All dollars are in constant 2014 dollars

Category 2014 2015Federal Funding Lost (mil $) $2,730 $3,292Total Jobs Not Created 23,518 29,113State Gross Product Lost (mil $) $1,692 $2,116Business Activity Lost (mil $) $2,684 $3,340State Tax Revenue Lost (Mil $) $99 $129County Tax Revenue Lost (mil $) $17 $23

The Economic and Employment Costs of Not Expanding Medicaid in North Carolina: A County-Level Analysis Ku et al Center for Health Policy Research George Washington University Dec 2014

SummaryExpansion of Medicaid is right

For economic reasonsJobsFunding to NCDecrease in cost shifting to private insuranceDecrease in unnecessary hospitalizationsHealthier workforceDecrease in unwanted pregnancies

For health reasonsDecrease in morbidity and mortality

For moral reasons