The People’s Grand Jury March 2, 2015 Charles van der Horst, MD, FACP Professor 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

Construction carpenters brick masons roofers Food Service fast food workers cooks waitresses Sales cashiers retail salespeople street vendors Cleaning and Maintenance housekeepers janitors landscapers Production textile operators laundry workers tailors Transportation bus drivers taxi drivers parking attendants Office and Administrative hotel clerks Support office 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 Note: People are classified according to the job they now have or the last job they held in the prior 12 months. 16K 66K Top 9 Professions of Working Uninsured North Carolinians 2014 Families USA

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

What the Affordable Care Act did: No pre-existing conditions No life-time cap on costs Portability Free preventive care and immunizations Insurance for 30 million uninsured Parity of mental illnesses with medical illnesses Decreasing growth in medical expenses Hospitals decrease readmission + infections Train more primary care doctors Restricts insurance administrative costs Fills Medicare donut hole Our Hope: Improve quality of care

Health Insurance and Mortality:

Where Poor and Uninsured Americans Live

Adjusted Hazards for Mortality among US Adults years: NHANES III Wilper et al AJPH 2009

Smith et al J Surgical Research 2013 Lack of Health Insurance increases cancer deaths

Sommers NEJM

Cost to Kentucky: $74 million in 2017 rising to $363 Million in 2021 Benefit 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 2014 September 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 Federal Funding Lost (mil $)$2,730$3,292 Total Jobs Not Created23,51829,113 State Gross Product Lost (mil $)$1,692$2,116 Business Activity Lost (mil $)$2,684$3,340 State Tax Revenue Lost (Mil $)$99$129 County 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

Summary Expansion of Medicaid is right For economic reasons Jobs Funding to NC Decrease in cost shifting to private insurance Decrease in unnecessary hospitalizations Healthier workforce Decrease in unwanted pregnancies For health reasons Decrease in morbidity and mortality For moral reasons