Guest post by two of my friends, collaborators and coauthors; Drs. Paul Shafer and Brad Wright:
As we approach an Election Day unlike any other in our history, North Carolina is one of only 12 states that has yet to expand Medicaid under the Affordable Care Act. Half a million North Carolinians stand to gain access to health care if we expand, almost all of it funded by the federal government. Instead we have watched for years, as rural hospital closures have reduced access to care and nearly 200,000 North Carolinians have fallen in the coverage gap, unable to qualify for Medicaid or receive financial help to purchase private insurance on HealthCare.gov. That was before the COVID pandemic hit. Now, one in five adults in the state are uninsured, tied for 7th highest in the nation. The state faces a stark choice at the ballot box this November.
In this election, the two leading candidates for Governor are current Gov. Roy Cooper (D) and Lt. Gov. Dan Forest (R). Gov. Cooper has consistently advocated for Medicaid expansion but has become particularly vocal in his support amidst the pandemic, noting that expanding Medicaid would not only provide coverage for those who have lost jobs but would also bring more federal funds into the state, bolstering the economy. By contrast, Lt. Gov. Forest is opposed to Medicaid expansion. He claims it would promote dependency and bankrupt the state. And, unlike other states, North Carolina cannot pursue Medicaid expansion by referendum so whom you vote for matters even more.
As members of a research team from Duke University, the University of North Carolina at Chapel Hill, and Boston University, we have been evaluating the performance of North Carolina’s Medicaid program as the pandemic has evolved. Medicaid is a critical part of the health care safety net, providing no-cost health insurance to low-income individuals and others in need. Ideally, it would prevent people from being uninsured if they lost their job during the pandemic. However, in states like North Carolina that haven’t expanded Medicaid, it is incredibly difficult for non-disabled adults who aren’t pregnant women or parents to qualify for coverage regardless of how little they earn.
Between February and August of this year, nearly 140,000 North Carolinians lost their jobs, while over 150,000 gained Medicaid coverage. At first glance, this might seem reassuring but over half of these new Medicaid enrollees were children (72,300) or women receiving only family planning services (7,950). The bottom line is that many North Carolinians became uninsured when they—or a family member through whom they were insured—lost their job, because they weren’t eligible for Medicaid.
States that didn’t expand Medicaid, like North Carolina, are seeing large increases in their adult uninsured rate, with adults in families suffering a job loss having nearly three times the increase in uninsured rate. The sad truth for North Carolinians in households earning less than the federal poverty line ($12,490 for an individual, $25,750 for a family of four) and without children at home is that they have to choose between paying the full cost of private health insurance or being uninsured. Of course, this “choice” is not really a choice at all because most people cannot afford the price of insurance on their own without help.
Medicaid expansion is long overdue in North Carolina. The COVID pandemic has shown us that the best—and only—way to solve the economic crisis is to first solve the public health crisis. Denying people the care and medications they need to stay healthy doesn’t help anyone, especially not during a pandemic. Health insurance is on the ballot in November. Make sure your voice is heard.
Bios
Paul Shafer is an assistant professor of health law, policy, and management and co-director of the Medicaid Policy Lab at the Boston University School of Public Health. Brad Wright is an associate professor and Director of Health Services and Outcomes Research in the Department of Family Medicine and co-directs the Program on Healthcare Economics and Finance at the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill.
OzarkHillbilly
It’s a no brainer, hence the Republican opposition.
p.a.
What’s the gov polling look like?
I know the NC lege is R, but what is the split? Any chance of a D majority? IIRC the state is gerrymandered to a fare-thee-well.
Some people don’t need to vote for the Leopards-Ate-My-Face Party: they’ll take a skinning knife to their own face.
MomSense
We lived this nightmare in Maine. We actually had expanded Medicaid before the ACA passed. It was part of a statewide plan to expand health coverage called Dirigo Maine. After the ACA passed, LePage spite cut the Medicaid program and kicked all the people between 100 and 140%FPL off the program.
It was so horrible. Parents desperately asking if they can at least keep their kids covered. People went without prescriptions, mammograms, substance abuse treatment, blood pressure checks. Lives were lost.
We finally took matters into our own hands and put Medicaid expansion on the ballot and became the first state where the citizens decided to take care of each other when the Republicans wouldn’t.
You can do this North Carolina! Vote!
Zinsky
Mr. Anderson, you and your associates are doing wonderful work! I hope we can save some semblance of the Affordable Care Act when President Biden gets the reins. Thank you!
Mike E
@p.a.: Cooper leads comfortably in what looks like a blue wave election. The two state houses may actually flip D if voters’ patience/perseverance lasts through having to fill in some 30 ovals on their two-sided paper ballots (I errantly voter for the R in the 7th circuit race; I wonder how many others did that, or worse, due to attention attrition) but if 5 or 6 seats flip, depending which chamber, the general assembly will halt the 10 year long TEA stranglehold. Inshallah!
p.a.
@Mike E: ????
frosty
Lt. Gov. Dan Forest (R) says Medicaid expansion would “promote dependency”. Promote dependency? Promote dependency!
WTAF!!?!??
taumaturgo
@frosty: Oh, the humanity!
Barbara
I hope after this election the Art Pope dynasty is over for good, but if Virginia and California are any guide, the Republican Party will only double down on the crazy. My daughter voted early in NC this year.
Yarrow
@Barbara: Nationally, QAnon is the future of the Republican party. Anyone left in the party who won’t join that cult is going to be voted out.
Barbara
@Yarrow: It will be unhinged in diferent ways. Earlier this year, several counties in Virginia seriously considered adopting their own militias. No, it’s not legal.
Geminid
Virginia Governor Terry McAuliff could not push Medicaid expansion through the Republican General Assembly in 2014. The Democrats made that an issue in the 2017 state election, and picked up 15 House of Delegate seats, on a republican drawn map. With votes from ten republican Delegates and 3 Senators, and all the Democrats, Governor Northam pushed expansion through in the 2018 session. Since then 400,000 Virginians have gained access to Medicaid. North Carolinians really do need expansion, and I believe the Democrats can pull it off it off.
Yarrow
@Barbara: I think it’ll be both/and. QAnon may not have thought up county-level militias but Q will proclaim it’s a great idea. That kind of thing.
Yarrow
@Geminid: Democrats in Texas are fighting hard this election to flip the State House. Governor election is 2022. Flip the State House, have a shot at Governor and Texas would be in line to expand Medicaid. Of course if the SC overturn the ACA I guess it won’t make much difference.
Barbara
@Geminid: No one even dreamed the Democrats would make so many gains in the General Assembly in 2017, and I know many regretted not pushing harder because of the three races that were separated by so few votes, one of which was tied and determined by a coin toss! But the writing on the wall was clear enough to garner necessary votes for expansion. Fingers crossed for NC.
WereBear
@frosty: The irony of people ordering $400 bottles of wine because mad billionaires fund their lives as Wormtongues worried about dependency.
gene108
I think Republicans at all levels of government have internalized the Trump Doctrine of “the cruelty is the point”.
jonas
Earlier this year some NPR show iirc was interviewing people in either North or South Carolina about Obamacare and Medicaid and such and this one woman, who had been laid off from her sort of decent job was now trying to hold down two minimum wage jobs with no insurance and she struggled with some underlying health problems. The interviewer said “well, you know, someone in your situation could get affordable health care via Obamacare.” “Oh, no,” she replied, “I’m not touching that. I don’t want anything to do with that man.”
Lots of horses out there led to water but refusing to drink…
jonas
@frosty: Once you’ve been to a doctor who treats your health problems, you just keep wanting to stay healthy more! It’s very insidious.
Mike in NC
Right now we are sitting in the ER of a hospital in South Carolina because my wife thinks she sprained an ankle late last night leaving a party. Fun way to spend Sunday.
Governor Cooper will do whatever it takes to get people Medicaid.
Steeplejack
@p.a.:
Comments are funny:
AM in NC
Thanks for this, Dave. I didn’t realize there are now only 12 states that haven’t ‘expanded’. This is such an own goal by NC! I think it’s a dream that we’ll flip the General Assembly to give Cooper a fighting chance, but with each cycle, we get closer and closer. AS you know, one big question moving forward is the courts and how they will continue to deal with gerrymandering/redistricting cases, since that is so central to us here.
low-tech cyclist
Shouldn’t that be ‘more’? I’d assume that persons and families under the FPL are covered by regular old pre-ACA Medicaid, but those just above the line aren’t.
ProfDamatu
@low-tech cyclist: I don’t know for sure if NC falls in this category, but I do know that in quite a few states, it used to be essentially impossible (or, IIRC, legally impossible) for able-bodied adults without children to obtain Medicaid, no matter how poor they were.