The state you live in shouldn’t determine whether you have access to health care, but right now, it does.
North Carolina is one of only 12 states that have not expanded Medicaid. As a result, many individuals across the state who work full time are stuck: they earn too much to qualify for Medicaid but are unable to afford health insurance through the Affordable Care Act marketplace. Oftentimes, this means making only slightly more than the income threshold to qualify for Medicaid.
These individuals fall into what is known as the Medicaid coverage gap.
In 14 counties across North Carolina, almost one in four working adults ages 19 to 64 are without health insurance — and the ranks of the uninsured grew significantly in North Carolina during the pandemic. Without the safety net of health care, hundreds of thousands of North Carolinians were especially vulnerable during the COVID-19 pandemic.
North Carolina’s health care system is vulnerable, too, particularly in rural parts of the state. Seven rural hospitals in North Carolina have closed over the past decade, and many more are vulnerable or at risk of closing. Hospital closures can be devastating to a community, forcing those in need of care to drive long distances and irreparably weakening the local economy.
By expanding Medicaid to those who currently fall into the coverage gap, policymakers can provide health insurance to nearly 600,000 more North Carolinians. Expanding Medicaid will not only protect the health care infrastructure, but will also significantly improve health care coverage, access and outcomes in North Carolina.
Thirty-eight states have leveraged federal funds to close this coverage gap. Take, for example, Virginia, where Republicans and Democrats came together to expand Medicaid. Since 2019, more than half a million Virginians have gained access to health insurance because the state opted to close its coverage gap. Unmet medical and other health needs, including primary care and mental health care, are much lower today than they were before Virginia closed its coverage gap. Tens of thousands of Virginians have been treated for high blood pressure and diabetes and almost 13,000 have been treated for cancer.
Many uninsured do not seek regular preventative care and rather only seek care in a crisis, when it is often too late for meaningful treatment for chronic diseases or life-threatening illnesses like cancer. This results in worse health outcomes for some of the most vulnerable populations. However, if you live in a state like Virginia that has expanded Medicaid, you are more likely to have access to this type of preventive care and treatment than if you live in North Carolina.
Medicaid expansion will make North Carolinians healthier by increasing early detection for cancer, heart disease and other life-threatening illnesses. It will also save rural hospitals from closing, ensuring access to quality health care while at the same time reducing uncompensated care and protecting the jobs of rural health care providers. When states close the Medicaid gap, they see a 62% decrease in the likelihood of rural hospital closures.
Expanding Medicaid is beneficial for a strong business climate, too. It strengthens local economies by creating new business activity, tens of thousands of new jobs and tax revenue. And, it is a way to support small businesses that cannot afford to provide health insurance to their employees.
Federal dollars flowing into the state’s health care systems have not just benefited patients. They have created new jobs in Virginia, too.
This summer, we urge policymakers to consider the health of the individuals and families who fall into this coverage gap and are unable to afford insurance. It may be the young man across the street indefinitely carrying the heaviness of multiple tours in Afghanistan, or the family just a couple doors down with two small children. By expanding Medicaid and closing the coverage gap policymakers can ensure vulnerable North Carolinas have access to the care they need.
Anna James is senior vice president of Public Policy and Government Relations at Sentara Healthcare. Andrew P. Stephenson is director of Government and Community Relations, Sentara Healthcare. They represent both Virginia and North Carolina.