The GOP assault on health insurance, North Carolina style

NC State Treasurer Dale Folwell.
NC State Treasurer Dale Folwell. cseward@newsobserver.com

I got a letter recently from the office of State Treasurer Dale Folwell threatening to take away my children’s health insurance. So did everyone else who works for the State of North Carolina.

Apparently Folwell believes that “ineligible dependents” are a significant drain on the N.C. State Health Plan for teachers and state employees, so he is conducting an “audit.”

Folwell demanded that I upload my children’s birth certificates on the State Health Plan’s cumbersome website, or their health insurance would be canceled.

It took me more than an hour to comply with this demand. How long will it take people who don’t have an advanced degree and a high-speed internet connection? I wondered. Then I realized: This complicated process probably isn’t accidental. More likely, it is part of the nationwide Republican assault on health insurance.

As everybody in the country must know by now, the Republican-led House of Representatives recently passed legislation that would take away health insurance from more than 20 million Americans. President Donald Trump, who promised on the campaign trail to make health insurance more widely available, somehow claimed this bill as a victory. The legislation is now being considered in the U.S. Senate.

Folwell has long opposed Obamacare and the extension of health insurance exchange markets in North Carolina. But as the state treasurer, Folwell has an obligation to protect the hundreds of thousands of state employees, and their dependents, whose health insurance he manages.

Instead, eligible children could lose their health insurance if their parents are unable to jump through the hoops of Folwell’s audit. Perhaps their birth certificates are not easily accessible. Perhaps their families don’t have a smartphone to photograph the document and an internet data plan to upload it. Perhaps their parents have difficulty following the poorly written instructions in Folwell’s letter.

All this to get a copy of my children’s birth certificates – which the State Health Plan already has in its possession.

Former State Treasurer Janet Cowell, a Democrat, demanded the same documents seven years ago in a similar audit, and I dutifully submitted them. At that time, the State Health Plan allowed photocopies of documents to be sent by mail, and that was the most widely used method for compliance. The current audit does not allow mailed documents.

The State Health Plan now requires that all new employees submit birth certificates and other documents in order to get dependent coverage.

How much fraud does he expect to find? Out of 100,171 minors audited in 2010, only 373 were ineligible, about one-third of 1 percent. But 3,875 minors, more than 10 times as many, lost their health insurance because their parents failed to submit the proper paperwork, according to a report by the consulting firm that managed the process.

Perhaps some of those children were ineligible – for example, if the parents divorced, a child might not have been a dependent of the parent who was a state employee. But the audit conducted no follow-up to find out.

When Folwell was asked recently about the need for the audit, he offered contradictory responses. First, he took credit for pushing for the audit seven years ago, when he was a member of the state House of Representatives, and claimed that the audit found thousands of ineligible dependents. Moments later, he seemed to forget all about the documentation that was collected in that audit.

I’ve been on the State Health Plan for 12 or 13 years and, for part of that time, I’ve had a wife and a son on the plan. I’ve never, ever been asked at any point to verify that they were my children or my wife. Ever.

Surely Folwell had to submit the same documents that I did. So is the current audit based on the treasurer’s forgetfulness, or is his forgetfulness a ploy to reduce the rolls through aggravating and duplicative demands?

The likely outcome of this exercise is that thousands of children will lose health insurance, at a time when national politics is making it harder for Americans to get insurance on their own.

Charles Kurzman is a professor of sociology at the University of North Carolina at Chapel Hill.