Opinion

PEG O'CONNELL: N.C. Missing out on good insurance news. Change it now

Monday, Aug. 29, 2022 -- North Carolina is missing out on one of America's most exciting doses of good news. Around much of the country the number of uninsured people is dropping but not in the Tar Heel state. North Carolina is too smart and too caring a place to miss out on a good thing. Expanding Medicaid is, as so many studies have indicated, a very good thing.

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Medicaid
EDITOR'S NOTE: Peg O’Connell is the chair of Care4Carolina, the 155 member statewide coalition committed to closing the health insurance coverage gap.

North Carolina is missing out on one of America’s most exciting doses of good news. Around much of the country, the number of uninsured people is dropping, even hitting all-time lows – but not in the Tar Heel state.

The benefits of having health insurance are enormous. A healthier workforce is a more productive workforce. And early detection of disease coupled with treatment means saving lives.

But while much of America celebrates, North Carolina is allowing itself to be left behind.

According to a new federal report, the national uninsured rate was at an all-time low of 8 percent in the first quarter of the year, with 5.2 million Americans gaining coverage since 2020. This is good news for people across the country and across the income spectrum.
Sadly, however, North Carolina is going in the wrong direction. Because of our inability to enact a North Carolina solution to close the coverage gap, we have seen an increase in the number of uninsured among our low income working neighbors.

For adults 19 to 64 with an income slightly above the federal poverty line, North Carolina saw a jump of almost one full percentage point from 2018 to 2020. If the past is prologue, then we are likely to see this number increase again if we don’t close the health insurance coverage gap.

So in a state that gets so much right, how did this item go wrong? While health care can be complicated, the answer here is straightforward. According to the report issued by the Office of Health Policy “states that expanded Medicaid since 2019 have experienced a decrease in the uninsured rates among low income adults.”

North Carolina has not yet closed its health care coverage gap by expanding Medicaid, and, by the lights of the new research, is paying a price.

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. For example, many North Carolinians clock in to jobs day after day, but they don’t receive health insurance from their employers.

Prior to the pandemic, approximately 400,000 North Carolinians lacked access to affordable health insurance. Now, The Kaiser Family Foundation estimates the number of North Carolinians who would benefit from closing the gap has grown by over 200,000.

So far, 38 states have moved to close their gaps by expanding Medicaid, with the federal government paying 90 percent of the cost. Federal law dictates that this funding level will not decrease.

The American Rescue Plan provides states with a new incentive: a two-year, five percent 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.

Medicaid is a key tool in screening for common diseases like cancer and fighting for recovery once a disease is detected. A recent study showed that cancer patients in ‘holdout’ states like ours experienced lower survival rates -- including a 31% increase in mortality risk among breast cancer patients.

Expanding Medicaid would also likely benefit North Carolinians who already have insurance. The former CEO of Blue Cross Blue Shield of NC, Brad Wilson, has written, “Closing the health insurance gap in North Carolina is an admirable goal … Studies suggest that one potential benefit would be lowering health insurance premiums, or materially mitigating the pace of premium increases.”

He went on to explain, “Expanding Medicaid means that more people have coverage, thereby reducing the losses medical providers incur for uncompensated care and ultimately recoup from private insurance premiums.”

North Carolina is too smart and too caring a place to miss out on a good thing. And expanding Medicaid is, as so many studies have indicated, a very good thing. The NC Senate agrees, having overwhelmingly approved a plan to expand Medicaid. The NC House passed its Medicaid expansion plan, but the chambers have yet to reach an agreement on a solution that works for both of them.

The members of the statewide nonpartisan Care4Carolina coalition stand with businesses, veterans, faith groups and families around North Carolina urging our legislature to close the coverage gap.

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