When U.S. Secretary of Health and Human Services Sylvia Burwell visited Charlotte last week, she dropped by the Observer for an interview about the state of the nation’s health.
Setting a standard, Burwell climbed the stairs, instead of taking the elevator, to our third-floor conference room. As the rest of us followed, she explained it’s one of her strategies to get exercise while she’s traveling.
Burwell, 49, formerly director of the White House Office of Management and Budget, seemed full of energy even when she was sitting still. With ease and authority, she zipped through multiple health care topics that have taken me years to understand. Among them: the Affordable Care Act. Bundled payment plans. Penalties for unnecessary hospital re-admissions. Precision medicine.
Her visit coincided with the announcement of a federal grant for Charlotte Community Health Clinic, which serves low-income residents. With the grant, the clinic will begin serving Medicaid patients. But there won’t be that many because N.C. legislators rejected federal Medicaid expansion under the ACA.
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Burwell noted that Kentucky Gov. Steve Beshear accepted Medicaid expansion through “executive authority” when legislators refused. Asked if she’s talked to N.C. Gov. Pat McCrory about taking a similar action, she said only that they had talked about a “range of issues” on her previous visit.
Burwell praised North Carolina for being one of the top ACA enrollment states. About 560,000 people signed up for new or renewed insurance in 2015, and 92 percent qualified for premium subsidies averaging $315 a month.
But those subsidies could be in jeopardy, depending on the U.S. Supreme Court’s decision in King vs. Burwell. Plaintiffs claim a provision in the ACA forbids states, such as North Carolina, from offering subsidies if they relied on the federal exchange to sell insurance instead of creating their own websites. A ruling is expected in late spring or early summer.
The Obama administration is confident Congress intended for subsidies to be available in all states, Burwell said. If the court rules otherwise, she said many will lose their subsidies, and their insurance will become unaffordable. It will be up to Congress or the states to fix the damage, Burwell said.
As an aside, Burwell said she didn’t realize, when she took the job, that her name would replace that of predecessor Kathleen Sebelius in the titles of pending legal cases.
“The president did not tell me that all Supreme Court cases change to my name,” Burwell said with a smile. “You’d think you might want to mention that.”
She said her husband has since questioned her decision to use his last name: “He’s like, ‘Maybe that wasn’t our best idea.’”