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N.C. Solution for Medicaid Expansion


Tim Rice Tim Rice
Timing is everything. Two weeks ago we learned that the Affordable Care Act (ACA) may remain for the foreseeable future. Is it perfect? No, far from it. However, thanks to provisions in the ACA, the number of North Carolinians without health insurance has dropped to an historic low. That’s good news.

Yet, the reality is that there are about 1 million of our North Carolina neighbors still uninsured, with about 500,000 having no affordable options. And, our state-wide uninsured rate at 11.2 percent is still higher than nearly every other state. Much of the additional coverage nationally has come from expanded Medicaid coverage, the health insurance program provided by the government to some low-income individuals and families. North Carolina has not yet expanded Medicaid, one of the main reasons the uninsured rate has not fallen as sharply here as in most other states. However, on Tuesday, April 10, a group of Republican legislators—serious people interested in serious healthcare solutions, held a news conference announcing their plan for creating a North Carolina solution for covering our state’s uninsured.

Extending coverage for a half a million North Carolinians will enable them to get timely, affordable health care, including preventive and primary care that can help keep them healthy, as well as meet their needs when they are ill or injured. Uninsured North Carolinians are at work every day in our state. They are veterans, farmers, volunteer firefighters, small business owners, fisherman and many service workers. They are the people that serve our meals, cut our hair, lead our church services and make our state work, every day of the year.

According to the Kaiser Family Foundation, most people on Medicaid who can work are already working. In fact, approximately 60 percent of Medicaid recipients are working and most have full time jobs. The majority not working are disabled, have caregiving responsibilities or are in school.

The reality is not expanding Medicaid is costing North Carolina jobs and economic growth. Research commissioned by Cone Health Foundation and Kate B. Reynolds Charitable Trust concluded that if North Carolina closes our health insurance coverage gap, we could create 43,000 more jobs statewide. About half of those jobs would be in the health care sector, the other half would be spread across construction, retail, professional, food service sector, and other local businesses. That’s real economic development that would benefit every county in our state.

This is not a rural versus urban problem. There are high rates of being uninsured in every county across the state. Many of our rural communities with high rates of uninsured residents also have the poorest health outcomes. North Carolina has some of the most restrictive Medicaid eligibility requirements in the country, which prevents thousands of low-income North Carolinians from getting health insurance.

The decision not to extend health insurance impacts everyone, not just those who are struggling to access the care they need and to chart their way to longer, healthier lives. It impacts our economy, the growth rate of jobs, and our state’s budget. We must find specific solutions to closing the coverage gap that will provide for access to comprehensive, affordable quality health care for all North Carolinians.

For North Carolina, the time is now. We welcome the discussion that started in earnest on Tuesday. This greater access to health care services matters for individuals, communities and our state economy.

Tim Rice is former president and CEO of Cone Health.