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Tom Bacon, Gene Cochrane, Jr., John Frank and Bill Pully: Finally, N.C.’s golden health care opportunity

Tom Bacon, Gene Cochrane, Jr., John Frank and Bill Pully: Finally, N.C.’s golden health care opportunity

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We’ve devoted our careers to strengthening health care so that our fellow North Carolinians can fulfill their enormous potential and our economy can compete with any in the world. The legacy of the organizations we led is found across North Carolina, where we worked with community members to creatively fill gaps in access to health care.

Now, because of actions by the N.C. General Assembly and the federal government as well as, of all things, a pandemic, we have a golden opportunity to finally close our state’s health care coverage gap.

Our legislature has prudently built up a rainy day fund of $7 billion, putting North Carolina in a winning position to remedy long-festering maladies, like the inaccessibility of health care. Meanwhile, the federal government has substantially upped funding and other incentives to offer insurance to certain working people and others by expanding Medicaid.

And finally, the COVID-19 pandemic has revealed just how fragile our lives, our economy and our health care system really are. It all adds up to a watershed moment — not merely a trumpet blast in the world of good public policy, but a chance to energize the lives of North Carolinians who are working hard, raising families and pursuing dreams.

The coverage gap refers to people who earn too much to qualify for Medicaid, but too little to qualify for a subsidy on the health-insurance marketplace. Many North Carolinians clock in to jobs day after day, but they don’t receive health insurance from their employers. And hundreds of thousands of working people still fall below the federal poverty line, which is around $26,000 for a family of four.

Of all the policy prescriptions to help these people, closing the gap through Medicaid would, experts agree, be the most comprehensive — with our rural communities benefiting enormously. Funds would sustain rural hospitals and clinics, and provide health insurance to workers who do not have an employment option that offers health insurance.

For a vivid picture of what the coverage gap means in your backyard, Care4Carolina, a 110-plus-member coalition of health, business and faith organizations, just unveiled a county-by-county search engine at

Whether you’re in an urban county or a rural one, you can find the tally of the thousands of neighbors who are uninsured. The Journal’s Richard Craver used the map to determine that in the 14-county region of the Triad and Northwest North Carolina, 123,956 are listed as being in the coverage gap, with Guilford County topping the chart at 35,194.

These counts include working parents and veterans, restaurant staff and entrepreneurs. You can also find the number of jobs closing the gap would create in hospitals and across local health care sectors.

North Carolina’s high number of uninsured people is alarming and very possibly the Achilles heel in our economic recovery. The good news, however, is that the time has never been better to close the coverage gap.

Thirty-eight states have already moved to close their gaps through a partnership with the federal government to expand Medicaid. The federal government covers 90% of the costs for these states. Federal law dictates that this funding level will not decrease. The deal was already very good. Now, it’s even better.

The American Rescue Plan provides states with a new incentive: a two-year, 5% increase in the federal match rate for Medicaid. For North Carolina, that would mean an influx of around $1.7 billion over the next two years. Official estimates put the cost of closing the coverage gap through Medicaid at $700 million over that span, which would leave $1 billion for the state to invest in other worthy endeavors.

A confluence of events — from our state’s strong fiscal stewardship to our nation’s response to a pandemic — have made this opportunity to help working people in both our cities and countryside possible. As health care veterans who’ve seen the anguish of the uninsured but never lost hope, we urge our elected officials to seize the moment and ensure a bright future for our great state.

Tom Bacon is the retired director of NC AHEC (North Carolina Area Health Education Centers); Gene Cochrane Jr. is the retired president of the Duke Endowment; John Frank is the retired director of the Healthcare Division, Kate B. Reynolds Charitable Trust; and Bill Pully is the retired president of the NC Healthcare Association.


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