Commentary

Must read: Report blasts idea of charging low-income people for Medicaid expansion

In case you missed it last week, Health Policy Analyst Brendan Riley of the North Carolina Justice Center’s Health Advocacy Project authored and released a powerful new report which skewers the idea of imposing premiums on low-income people as part of a Medicaid expansion proposal. The central finding: The people in the coverage gap are already barely getting by and if they are forced to pay for health insurance, the whole purpose of expansion will be greatly undermined.

This is from the introduction to “Health Coverage or Food on the Table? North Carolinians Face Impossible Choices if Medicaid Expansion Requires Premiums”:

As North Carolina decision-makers explore ways to expand Medicaid and close the state’s coverage gap, some have proposed requiring beneficiaries to pay a monthly premium in order to maintain their coverage. Given the economic realities facing those living without health care coverage, as well as other states’ failed experiments, it is clear that requiring premiums of Medicaid expansion enrollees would create major affordability barriers for North Carolinians who stand to gain health insurance coverage.

North Carolinians who would benefit from expansion earn incomes that are already insufficient to cover their monthly household budget costs for housing, food, child care, and other necessities, leaving little to nothing to pay for health care.

The evidence from other states is clear: premiums create barriers to health coverage and care for individuals with low incomes due to their inability to pay. When people lose Medicaid because of premium requirements, it reduces their ability to access health care and puts an even greater strain on already limited household budgets.

If lawmakers impose premium requirements on new Medicaid enrollees, a significant coverage gap will remain. People with low incomes will remain uninsured due to premium costs, leaving too many North Carolinians unnecessarily uninsured and unable to treat their health conditions.

Moreover, without full closure of the current coverage gap, the state won’t be able to draw down all available federal funds, nor will we realize full fiscal savings for agency budgets currently funding health care costs for uninsured North Carolinians.

The report concludes this way:

Medicaid expansion provides North Carolina with a tremendous opportunity to draw down billions of new federal dollars and provide health coverage to hundreds of thousands of uninsured people. Given the 90 percent federal match on Medicaid expansion enrollees, our state would benefit from maximizing enrollment. The more people enroll, the more federal dollars come into the state, in turn generating economic activity, creating jobs, and producing fiscal savings for the state budget.

Any proposal that erects barriers to enrollment would limit these benefits. Ample evidence from other states makes clear that requiring premiums would create administrative hurdles and affordability challenges for North Carolinians with low incomes in need of health coverage. Instead of charging unaffordable premiums that unnecessarily take coverage away from people in need, lawmakers should design a proposal that will maximize federal funding to cover the most North Carolinians eligible.

At the end of the day, our state will not fully close the coverage gap if lawmakers charge premiums to North Carolinians who become eligible for Medicaid expansion.

Click here to check out the full report.

One Comment


  1. Paul Smith

    April 2, 2019 at 10:03 am

    Republican, Democrat, and Unaffiliated voters who have a heart for constituents caught in the coverage gap need to step up to support Medicaid Expansion. Being against to Expansion due to its relationship to the ACA developed under the Obama Administration or due to offending Trump’s base or due to inaccurate reasoning that it would be expensive to NC taxpayers are wrong. We need to treat people caught in the gap as if we care for them. This is the trend throughout the country. It’s past time we join them.

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