That the American health care coverage system is broken shouldn’t come as a shock to anyone, even proponents of the 2010 Affordable Care Act who thought Obamacare would make coverage affordable for everyone. But as long as workers with employer-subsidized health care are forced to rely on the generosity of capitalists for their health and well-being, there will continue to be crises like the one currently unfolding with soon-to-be unemployed workers at Pactiv-Evergreen’s Haywood County facilities.

James and Brenda Porcello are thankful for many things this fall, and near the top of that list is Jan Plummer, of Waynesville, a Mountain Projects employee who was among those who helped save James’ life just a few months ago.

People have a new opportunity to enroll in health insurance for 2021 on HealthCare.gov, but only for a limited time.

By Steve Wall • Guest Columnist | Why do we even need any medical insurance programs or Social Security?

Well, because about 500 elderly folks in Haywood County are in nursing homes with their fees paid by Medicaid. And over 4,500 of our community’s children are enrolled in Medicaid. Virtually anyone over 65 gets their medical bills paid primarily paid by Medicare. And most people over 65 depend on Social Security to escape the poverty that threatened their  aging family members before 1936 and President Roosevelt. 

Four-time freshman legislator and recently re-elected Rep. Joe Sam Queen, D-Waynesville, launched into this year’s legislative session by hosting a trio of town hall meetings across his district, but if the ones held in Jackson and Swain counties were anything like the one in Waynesville on Feb. 16, there’s just one thing on people’s minds — expanding Medicaid. 

Worries last month over the potential defunding of local social service agency Mountain Projects’ Obamacare Navigator program became real when the organization wasn’t selected for funding, but a solution has now emerged thanks to one of North Carolina’s largest private trusts. 

More than a month has passed since Mission Health announced it would terminate its contract with Blue Cross Blue Shield of North Carolina on Oct. 5, leaving thousands of BCBS policyholders in Western North Carolina to pay more for out-of-network services at Mission facilities or seek care elsewhere.

The nonprofit healthcare system and the insurance giant have since been embroiled in a public relations battle that has played out through newspaper ads and social media campaigns. On one hand, Mission says it attempted for six months to negotiate with BCBS for better reimbursement rates for services but that BCBS — with its 72 percent market share — wouldn’t budge.

On the other hand, Blue Cross says Mission’s cost of services were already higher than most other hospitals in the state. Unlike other hospitals that renewed their contract with Mission, BCBS said Mission administration wasn’t willing to work “to slow down unsustainable cost increases.”

There’s plenty of finger-pointing still going on, but BCBS customers — especially those who have a BCBS plan through the federal health care exchange — will be the ones to suffer if the two entities don’t reach an agreement.

An Aug. 10 release from Mission announcing it would allow health insurance exchange BCBS policyholders to remain in-network made it seem like the two parties were beginning to iron out some details, but BCBS quickly issued its own press prelease rejecting Mission’s proposal.

Specifically, Mission Health offered to stay in-network and accept its current payment rates with no increase from BCBS for care provided to anyone covered by a policy purchased on the federal exchange since BCBS is currently the only provider offering plans on the exchange.

While employers can choose another provider to offer benefit plans to employees and seniors purchasing Medicare Advantage coverage have multiple choices available, consumers who purchased their health insurance coverage on the exchange unfortunately only have one choice.

According to a press release, Mission Health would honor current payment rates — the “forever zero” approach BCBSNC has demanded — for all persons insured through the exchange for 2018 or until such time as a new agreement is reached with BCBSNC that covers all care provided to all patients.

“We take our responsibility as Western North Carolina’s only safety net health system incredibly seriously,” said Ronald A. Paulus, MD, president and chief executive officer of Mission Health. “Our commitment goes far beyond providing nationally recognized, high quality, cost-effective healthcare to our community. We understand that those purchasing insurance on the exchange are among the most vulnerable in our region and have no alternative, so it is our responsibility to ensure that access to health insurance — a life transforming event — remains available to everyone. By accepting BCBSNC’s ‘forever zero’ approach for these individuals, we can help protect those who have exchange-based insurance, some being insured for the first ever time in their lives.”

Blue Cross NC President and CEO Brad Wilson acknowledged Mission’s attempt to partially rescind its contract termination, but rejected the offer.

“We were disappointed when Mission Health decided to unilaterally terminate those contracts last month,” he said. “With today’s proposal, Mission Health continues to turn its back on senior citizens, state and county employees, businesses and taxpayers across Western North Carolina. This is unfair to tens of thousands of other members; therefore Blue Cross NC has no choice but to reject this offer.”

Wilson said BCBS remains ready and willing to negotiate on behalf of all WNC members as soon as Mission Health fully withdraws its termination. He also pointed to a recent study — www.wallethub.com/edu/ states-with-best-health-care/23457/ — that validates North Carolina already has some of the most expensive health care in the nation, and every increase in hospital costs leads directly to even higher premiums.

“We hope that Mission Health reconsiders its decision to terminate our contracts. In the meantime, we will continue to work with Western North Carolina’s other doctors and hospitals — who share our goal of making quality, affordable health care available to as many North Carolinians as possible,” Wilson said.

The current contract between Mission Health and Blue Cross Blue Shield of North Carolina expires at midnight on Oct. 4, 2017. Negotiations must result in a new agreement by midnight on Oct. 4, 2017, for Mission Health to remain in the BCBSNC network for all consumers, including those covered by policies purchased on the exchange. This announcement effectively excludes those on the exchange from being impacted by BCBSNC’s unwillingness to even speak with us about a contract critical to Mission Health’s long run survival.

For more information from Mission, visit www.standwithmission.org.

As Republicans in Congress attempt to repeal the Affordable Care Act and Mission Health threatens to cancel its contract with the largest health insurance provider in Western North Carolina, thousands of people are wondering whether they will be covered and what the cost might be.

The Affordable Health Care Act got a bit closer to repeal last week as the U.S. House of Representatives passed legislation that could drastically affect millions across the country and across Western North Carolina.

“More for less” — that’s the message Western North Carolina Congressman Mark Meadows, R-Asheville, is trying to send to Congress and President Donald Trump about the Affordable Care Act.