It's been a  year since President Obama signed the Affordable Care Act, and opponents are doing all they can to dismantle, de-fund or sabotage it.

I've looked at a lot of the coverage today, and I can tell exactly what audience the different reports are playing to. The Economist called it Obamacare (the first dead giveaway that the author or editor doesn't approve), and then went on to misrepresent what the law has accomplished thus far and the long-range costs.

Fox News just focused on the Kaiser Family Foundation survey that found Americans still pretty evenly divided. Maybe Fox should mention that the majority of people who flat-out disapprove believe a lot of the lies that Fox itself has put out there. People who don't get a majority of their news from Fox are much less likely to believe the lies about the Affordable Care Act and much more likely to view the law favorably.

Go figure.

I try very hard not to be political about health care, but the ACA was the best we could manage to get and people who have no solution other than go back to deregulation just want to pull it apart so the big insurance companies, the pharamaceutical companies and medical device manufacturers can run rampant again.

This opposition is about big money being able to trample the rest of us, not about what's good for consumers. What's good for consumers is for everyone to have access to quality care.

I celebrated this anniversary by joining the board at WNC Health Partners, which seeks to find ways to have people work together to strengthen the safety net and help people get the care they need. I'm pretty excited about it.

At the beginning of the meeting, the board chair asked us each, "What do you want?"

My answer was that I want everyone to have access to quality, affordable health care. Period.

Right now the health care safety net, which includes mental health care, looks like Swiss cheese, according to Scott Rogers, who runs a free clinic here in Asheville. His clinic turns away about 150 people a month because of capacity issues.

Mental health care is almost nonexistent here. People are landing in jail and in the emergency room -- probably the two least appropriate places for them -- and being released with only enough medication to cover two days when very few of them can get a prescription in less than a week.

I'll be honest: I don't think the law goes far enough, but at least it moves us ahead.

So do we go back to where we were before or do we at least take some steps forward?

The insurance company power grab, NC House Bill 115, was pulled from agenda of the NC House Health and Human Services Committee, which met today.

Two weeks ago, when I was in Raleigh for the last committee meeting, the agenda was to get this disastrous bill through as quickly as possible. When legislators were inundated with calls and e-mails against it, and about 100 people showed up to fill the gallery, committee members apparently thought better of it and after hearing from the NC Commissioner of Insurance and a couple of attorneys, they decided to allow the bill's author (Rep. Jerry Dockhart) to speak at today's meeting.

Yesterday we learned the bill was pulled from the agenda.

That means it's no longer on the fast track, but we believe it probably is being worked on in closed sessions without input from advocates -- or anyone else who might disapprove.

H115 hasn't gone away, but we have had an impact. Please let your legislators know we don't want a few cosmetic changes to the bill; we want a consumer-friendly bill and we'll be watching what they and the insurance companies do.

Wednesday is the one-year anniversary of the signing of the Affordable Care Act, and Americans are still pretty divided about whether it's a good thing.

I'm convinced public opinion would be a lot more positive without the sustained and much publicized attacks from the right, fueled and funded by insurance companies, the pharmaceutical industry and medical device manufacturers. They don't want to be regulated, and they have enough money to be a disproportionate voice in the discussion. They buy ads and then threaten to withdraw their ads if media don't tell their "side" of the debate. Ads are the bread and butter of media, and more and more, the media cave to the demands of big business; in fact, they are big business themselves now.

The Kaiser Family Foundation has done surveys frequently to find where the American public stands on the ACA. At the one-year mark, 42 percent favor it, 46 percent don't and 13 percent said they don't know or they refused to answer. All through the year, the results have been about the same, with favorable and unfavorable meandering upward and downward, crossing each other several times.

Other surveys have shown that your opinion of the law depends on where you get your information. People who get most of their information from Fox News are more likely to oppose the law.

Why? Because so much of the information Fox gives out is wrong. There are no "death panels," we CAN afford to do this, it won't offer illegal immigrants care, and it is NOT a socialist takeover of the health care system.

But nearly half of Americans believe all that disinformation because big corporations have to money to make them believe it. They have tainted the debate with the poison of these lies and many Americans believe what's being fed to them.


The new Republican majority in Raleigh passed a bill last month that would exempt North Carolina from the Affordable Care Act. Gov. Perdue, knowing the law wouldn't stand, at first decided to ignore it and let it stand instead of waging a veto fight.

But NC Attorney General Roy Cooper  took a look at the law and advised her to veto it because the fight really was worth iy. Perdue followed his advice, and the attempt to override the veto failed.

Until last Thursday.

The Republicans left the legislature early in the afternoon to attend a closed party meeting across the street, with two small items left on the agenda. After a couple of hours, most of the Democrats left to go back to their districts for the weekend.

The Republicans came back and decided they could bring the legislation back up using an arcane parliamentary rule and override Gov. Perdue's veto.

House Minority Leader Joe Hackney made a deal with House Speaker Thom Tillis and agreed to suspend the rule, leaving the veto intact -- for now. 

From now until the end of this session, sometime late next year, Republicans can call for another vote to override Perdue’s veto anytime they want, and Tillis said that will be their policy with all vetoes, to keep the vetoed legislation alive with a similar bending of the rules.

Tillis patted himself on the back for taking the high road here, but I'd only call it high if we were all on something. I don't believe this is what the voters of Notrh Carolina want.

Members of the legislature are supposed to work in the best interests of the people, not the corporations, and not themselves and their power.

The NC House Health & Human Services Committee met this morning to discuss House Bill 115. I think they were a little surprised to see the gallery filled to overflowing with opponents of the bill.

People came from all across the state, representing probably more than a dozen organizations. Kay Zwan and I are activists from opposite ends of the state, and we sat side-by-side, feeling like we could stare down the committee by ourselves.

Adan Searing of the NC Justice Center's Health Access Coalition, said he heard that as of last Thursday, the committee intended to push the bill through to the Insurance Committee, which is chaired by the representative who introduced the bill, Jerry Dockham.

Instead, three people testified, representatives asked a lot of questions, including some pointed questions about why the bill allows the insurance companies so much control over the benefits exchange and provides so little transparency.

NC Insurance Commissioner Wayne Goodwin presented the unfinished bill that was being worked on by the NC Institute of Medicine panel, one point of which is a board that includes only people with technical expertise and no direct ties to insurance companies, hospitals or other business interests. Attached to the seven-member board would be five nonvoting advisory groups that include consumers and insurance companies, putting us on the same level.

Goodwin also recommended public meeting and records laws apply to the exchange, something H115 lacked.

The good news is that the HHS Committee posponed rushing H115 through. We advocates got enough of the media to notice this to get people asking questions of their representatives.

Big Insurance and their friends in the House had hoped to slip this through unnoticed. They realized this morning that isn't going to happen.

Now we have to keep up the pressure so they know we're going to keep watching.

Bad doesn't begin to cover it.

Not long after I came to North Carolina in 2001, I started hearing about "reform" of the system. In March of 2002, I went to a Q&A event at the Mountain Area Health Education Center, where state officials and the director of the local mental health area program would answer the public's questions about reform.

The Area Programs, which were one-stop mental health centers for people without insurance, would no longer be allowed to do treatment; that was being replaced by "a choice from a wide array of providers in the community." In other words, the state privatized it.

At the Q&A, no one could answer many questions. Larry Thompson, director of Blue Ridge Area Program, kept answering, "We don't know that yet." I figured either he was very stupid or we were in deep trouble.

Turns out Larry is a very intelligent man.

State officials answered questions with a lot of  jargon and very few specifics.

As reform was about to kick in, service providers still didn't know what the reimbursement rates would be or what services would be paid for. In other words, if I had been a provider, I was being asked to sign on without knowing what my duties or my pay would be.

The state began shutting down beds in its four psychiatric hospitals. Broughton, the hospital serving the western part of the state went from 893 beds at its peak to 278. People were being released into the community with no treatment plan in place, and some died as a direct result.

Meanwhile, less and less money was dedicated to mental health services. Community hospitals' emergency rooms were and are overflowing with people in desperate need of help. One hospital CEO in the very western part of the state told me about coming in at 8 a.m. and finding a terrified patient handcuffed to a gurney. The patient had been there for hours as the hospital staff tried desperately to find an appropriate bed for him.

Broughton, meanwhile, was operating at more than 110 percent of capacity, and beds were still being cut.

On top of that, the rules were changing weekly and private service providers were undergoing audit after audit. They began going out of business at an alarming rate, even the biggest ones.

The state legislature asked then-DHHS Secretary Carmen Hooker Odom for a report on what was needed to bring the system up  to speed, but the report didn't come. It was two years before anything was forthcoming.

Things have gotten so bad that the US Justice Department has opened an investigation of the system.

Our jails are full of people who need treatment in an appropriate place, community hospitals' emergency rooms and psychiatric units are filled to overflowing, and there has been a proposal to close all the local management programs around the state and give the whole system to a private company to manage.

The company, Value Options, is based in Richmond, Va. It operates in North Carolina because Odom took the function of case reviews away from the local amnagement agencies and turned it over to Value Options, then cut the budgets of the local management agencies by one-third. That was a disaster, sending costs spiking because no one close to home was reviewing patients' needs, so inappropriate services were being authorized.

Should we privatize the entire mental health system in North Carolina? Absolutely not. Things are bad enough without handing everything off to a company whose first consideration has to be its bottom line.

The Republican majority in the NC House is planning to ram through the law giving Big Insurance control of the Health Benefits Exchange; they have scheduled a vote for Tuesday (March 8).

A little history, in case you missed previous posts.

By 2014, each state must have an Insurance Exchange, where people who don't have insurance with their employers will buy health insurance. The exchanges are intended to be a simplified marketplace with consumer protections built in.

North Carolina was drafring legislation for the exchange through a diverse panel that was commissioned by the NC Institute of Medicine, a nonprofit, quasi-governmental advisory group. The panel consisted of consumers, policy experts and more -- including insurance companies and brokers.

At each meeting, the insurance companies asked for things that were just plain inappropriate, like the ability to sell as many policies as they wanted, making the marketplace confusing and increasing the likelihood that consumers would be steered to low-premium but very high-cost policies with deductibles of $10,000 and more. Of the 15 insurance companies doing business in the state, 14 have asked for a waiver of the 80 percent rule. They wanted to gut the appeals process and keep any company from being thrown out of the exchange for abuses.

They wanted voting seats on the board of directors. Nearly all of the people who spoke on the issue (including me) said it would be a clear conflict of interest to have insurance companies on the board of the entity that's supposed to regulate them.

When that was shot down, a H115 miraculously appeared. Blue Cross Blue Shield denied it wrote the bill, but it supports it wholeheartedly.

The bill, should it become law, would cause massive damage, gutting reform and still forcing more than 1 million North Carolinians to buy insurance from companies that make their own rules.

We need to stop this bill. I have e-mailed my representative, Tim Moffitt, and asked him to let the Institute of Medicine panel finish its work before approving anything else.

I plan to be in Raleigh on Tuesday. I hope others will be there with me.

The News & Observer in Raleigh has written about the attempt by Big Insurance to take over the Health Benefits exchange. That makes one newspaper in the state that has shown some interest in the power grab.

Alan Wolf and Lynn Bonner have written an article (read it at in which Blue Cross Blue Shield says it did not write the bill but does support it.

This is a somewhat complicated issue. A friend of mine who is in radio news says the story is too complex to cover in the five-minute, top-of-the-hour broadcast. Listeners just want the basics, and nothing that requires too much thinking, before they get back to the music.

But newspapers have the ability to explain this to people; most of them just won't, or they're too short-staffed to give any one person time to get familiar with the subject and explain it.

That leaves it to big-mouth advocates like me to get the word out.

Anyway, thanks to Alan Wolf and Lynn Bonner, my heroes of the day.

After eight calls to Rep. Tim Moffitt's office, I decided to give it one more try this morning. His aide told me he had a very busy day. I reminded her I'd been calling for two weeks and I was in Raleigh and just wanted to stop in. She hemmed and hawed a bit and I hung up thinking my post about Moffitt last week was right.

But five minutes later, he called back and said he'd be happy to make time for me, and then asked if I would be kinder to him on the Internet.

So we met. Mostly, I think he and I will disagree on things, but we did find common ground in the mess that is our mental health system in North Carolina. He has seen people he knows suffer because of it.

He also knows what it is to go without health insurance, although he and I disagree on how to fix the system.

I will work with him where I can and hope he can meet me halfway on stuff.

For now, Tim, I'll be kind.