JOHN RAILEY: Business leaders, pediatricians, say Medicaid expansion is practical and right

Posted May 28, 2019 5:00 a.m. EDT

Medicaid expansion

EDITOR'S NOTE: John Railey, former editorial page editor of the Winston-Salem Journal, is executive director of The Partnership for Prosperity, an initiative fighting poverty in Winston-Salem and Forsyth County. This column was initially published in The Winston-Salem Journal.

North Carolina has never been closer to Medicaid expansion, but the action is still a long way off in our General Assembly. That’s not from a lack of effort. For months, organizations and individuals statewide have waged a well-coordinated effort to push expansion through in our state, one of a relative few in the country that has not gone for expansion. It’s past time that happened.

Today at 1 p.m., Care4Carolina, a statewide coalition pushing for expansion, will hold a meeting at Wake Forest Biotech Place in Winston-Salem to rally public support.

The expansion effort has met an equally strong push from opponents, who worry about the costs. The expansion advocates keep pounding away, expanding their bipartisan base. Expansion supporters include Winston-Salem businessman Don Flow. He recently joined 13 other state business leaders in a public letter making the case and addressing the cost concerns:

Unfortunately, 13 percent of North Carolinians under 65 are uninsured. These are our neighbors - they are construction workers, retail employees, restaurant workers, veterans and farmers; they are the bedrock of our communities. Currently, a family of four with working parents cannot earn more than $9,000 to qualify for Medicaid. But they earn too little to qualify for federal subsidies to buy their own insurance.  They fall into a coverage gap.  The good news is that we can follow the lead of 37 red and blue states and close the gap.  Doing so would allow an estimated 500,000 North Carolinians to gain access to affordable health care. … And here’s the clincher, closing the gap is fiscally responsible. It requires zero state dollars as the federal government pays 90 percent of the costs and the rest is paid by hospitals and health plans.

Many doctors also support expansion, including a group of Winston-Salem pediatricians who joined their colleagues visiting legislators in Raleigh on May 15. One of the local pediatricians was Kimberly Montez. I joined Montez and her colleagues, who calmly made their case to legislators. In a follow-up email to me, Montez said:

Many legislators are not aware that closing the Medicaid coverage gap for low-income working parents is crucial to the health, development and growth of their children. Mothers who have health insurance before conception are more likely to attend prenatal visits and give birth to healthy infants. Children whose parents have health insurance are 29 percent more likely to attend a preventive visit and receive vaccinations. Low-income parents with health insurance are more likely to spend time with their children and less time worrying about their health, out-of-pocket medical expenses or medical debt. Meeting with many state legislators with a group of pediatricians for White Coat Wednesday, it was clear that all support the health and well-being of children in and around Forsyth County; for that we are thankful. However, many were not aware that the health of parents is inextricably related to the health of their child, for which closing the Medicaid coverage gap is imperative.

One of her fellow Winston-Salem pediatricians, Dan Krowchuk, could not get to Raleigh as he had to stay in Winston-Salem for work. But he, too, made a strong case for expansion in an email to this columnist:

I believe that health care is a right not a privilege, so Medicaid expansion is a step in the right direction. … As a pediatrician, I'm grateful that the vast majority of North Carolina children have health insurance as Dr. Susan Mims, president of the North Carolina Pediatric Society, wrote in a recent column. That's a terrific accomplishment but, as Dr. Mims notes, our next job should be to ensure health care for parents and other adults who help shape the lives of children in our communities. Being a parent is tough under the best of circumstances. But if you have health problems and lack access to care, it's difficult to be your best for your children. One area of particular concern linked to adult health care is infant mortality - a significant problem in our state. Although women are eligible for Medicaid during pregnancy, they may lack health insurance and access to care before and between pregnancies. Providing them with health care, including preventive services, can improve the lives of their babies.

State Rep. Donny Lambeth of Forsyth County, a former executive at Wake Forest Baptist Medical Center, has pushed an expansion bill, HB 655, the NC Health Care for Working Families Act. With a requirement that most expansion recipients either be working, seeking a job or in a job training program, the bill is not perfect. But it still has a chance of being heard in the legislature this session.  And there’s a better chance that its expansion principle will make it into the state budget during wrangling between the governor and legislative leaders in a few weeks.

That inclusion needs to happen.

The doctors, business leaders and many others make sound arguments: Medicaid expansion is overdue in North Carolina, for the good of us all.

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