Commentary

Another byproduct of the Medicaid Blockade: Catastrophic medical bills, massive debt for families

There are a lot of terrible problems that North Carolinians have been forced to endure as a result of the Medicaid Blockade that state legislators continue to enforce. Here’s another especially awful one: Every year, an average of 14,776 North Carolina families experience financial distress as the result of catastrophic medical bills. This is the case even though 67 percent of families lacking health coverage have either a full-time or part-time worker in the family.

Happily, in spite of the Blockade, the Affordable Care Act has helped millions of people. Prior to passage of the ACA, 41 percent of adults between ages 19 and 64 years reported having trouble paying medical bills and/or accumulated medical debt. As the ACA has increased Americans’ ability to access more affordable health coverage, however, the number of people reporting difficulty paying their bills fell by 13 million people in the past five years. Unfortunately, the Blockade has prevented these benefits from flowing to hundreds of thousands of other people who need them.

Not surprisingly, there is a strong association between medical debt and lack of health care coverage. And, of course, thanks to the Medicaid Blockade, there are 500,000 North Carolinians in the coverage gap and thus at risk of facing catastrophic medical bills. What’s more, many of these insurmountable medical bills result from one-time events. Take, for example, Jacqueline and Darian. Five years ago, Darian experienced a workplace injury that has left him unable to return to the labor force. Even though Jacqueline still works, she does not have employer-sponsored health insurance. Unfortunately, both are in the coverage gap.

Darian’s workplace injury resulted in a medical bill of close to $20,000. That is a lot of money for most families and completely beyond the means of low-income working families. Luckily, Darian was among a relatively small group of people who are able to obtain charity care. But, while Jacqueline and Darian appreciate the charity care they received, they understand that their fiscal, physical, and emotional health are still at risk in the event of another accident, unforeseen injury or health emergency. What’s more, both also recognize that they are not alone in their financial fragility; they understand that medical debt and its many related impacts are a huge community-wide plague.

The bottom line: People like Jacqueline and Darian understand only too well that even hard working North Carolinians can lose their ability to work and contribute financially to their communities if they lack access to health care and remain uninsured. And thanks to the Medicaid Blockade, this is a huge problem that’s not going away any time soon.

Commentary

Middle-aged, stuck in the coverage gap and still years away from Medicare

Seventeen percent of adults stuck in the Medicaid coverage gap are between the ages of 55 and 64 years and many have worked most or all of their adult lives. What’s more, 56 percent of adults in the gap are currently working. Unfortunately, when there are economic downturns, some hard working individuals lose their jobs.

Sonya’s story reflects the stories of many older adults that have worked and paid their taxes most of their lives. Unfortunately, Sonya lost her employer-sponsored health coverage when she lost her job. Now that Sonya no longer has employer-sponsored health coverage and no longer qualifies for Medicaid because her youngest child has aged out, she has limited to access the health care she needs.

While the Affordable Care Act has helped many people gain Marketplace coverage, Sonya was unable to enroll given her financial situation. She tried to gain coverage through Social Security disability insurance as she has chronic back issues that impact the type of work she can do. Unfortunately, she was denied disability coverage. This leaves Sonya in the coverage gap. Like 500,000 other North Carolinians, Sonya does not meet the eligibility for Medicaid and cannot afford to purchase coverage on the Marketplace. She is, at once, too well-off and too poor.

Thanks to the Medicaid Blockade led by Speaker Moore and Senate President Berger, Sonya is in the coverage gap. She has over five years until she can obtain Medicare coverage. Thus, Sonya is delaying the preventive and urgent care she needs to help improve her chronic back conditions and behavioral health concerns. Like many fellow Tar Heels, Sonya is working hard to pave her own path to coverage. She saves money to see a health provider for her ongoing health concerns. She is even going back to school to become a counselor. Sonya is hoping that with higher education she will be able to get a job that will offer insurance. For now, however, likes hundreds of thousands of her fellow North Carolinians, financial ruin is just one accident or one unforeseen illness away.

Commentary

Isn’t it ironic? The Medicaid blockade prevents health aides from getting health coverage

Obtaining health coverage can be enormously difficult for childless North Carolinians of modest income. In North Carolina, they are not eligible for Medicaid. Add to this the fact that many have a difficult time paying for private insurance and that several jobs do not offer employer-sponsored health insurance and it’s a wonder that any are insured. The General Assembly’s Medicaid Blockade just makes matters worse.

What’s even more frustrating about this situation is that many childless adults in the coverage gap have been mislabeled as undeserving “able-bodied” adults. Opponents of Medicaid expansion ignore the fact that 56 percent of adults in the coverage gap are employed. Thus, they do have “skin in the game.” For families in the health insurance gap, more than 65 percent have a family member working at least part-time.

The explanation for why so many employed people lack insurance are varied, but one of the most obvious is this: their employers don’t want to pay for it. And so instead of employing people full-time, they keep their employees trapped in the “gig economy.” A report in the most recent issue of the journal Health Affairs examines this problem. The researchers note that many employers are shifting to contract workers or other types of temporary employees. So even though someone may have a “job,” he or she may have no access at all to employer-sponsored health coverage.

Dorothy is a home health aide and a classic example of this destructive phenomenon. Though she works hard taking are of vulnerable people, she along with 500,000 other North Carolinians, remain mired in the coverage gap. Legislators who continue to push the Medicaid Blockade should understand that workers, like Dorothy, who actually help provide health care to others, are stuck in the coverage gap. Even though Dorothy takes care of her health and tries to be proactive with prevention, it is obviously not enough. Like everyone else, she needs decent and affordable health insurance.

Opponents of Medicaid expansion should realize that workers need to be healthy in order to keep people working. When North Carolina has a healthy workforce, it will attract more employers and businesses to want to invest in our state and build up the labor market. Unfortunately, the supporters of the Medicaid Blockade continue to prevent North Carolinians from becoming healthy and more productive workers even, as in the case of Dorothy, when they got to work everyday attending to the health care needs of others.

Commentary

Meet another woman whose life the conservative Medicaid blockade is harming

Even though North Carolina’s uninsured rate has fallen to  11.6 percent as a result of President Obama’s Affordable Care Act, the state still gets an average-to-failing grade (a D+) when it comes to women’s reproductive rights and overall health and well-being. And while there are obviously lots of factors that contribute to this poor grade, one of the most obvious is the failure to expand Medicaid under he ACA. As with other southern states, the shortsighted decision of North Carolina lawmakers to block the full implementation of the ACA so that more women can gain access to the health care they need is producing large amounts of unnecessary harm and suffering for thousands upon thousands.

Take Michelle for example. Medicaid expansion would allow her and thousands of women like her to finally have access to the primary and preventive care most people take for granted. Michelle owns her own small business, a hair salon, but considering how business fluctuates, she does not earn enough to qualify for financial help to enroll in Marketplace coverage. Michelle’s eligibility status is further complicated in that even though she is a parent, she makes too much to qualify for Medicaid. Thus, Michelle and many hard working parents like her remain uninsured. In addition to worrying about receiving the primary care she needs to remain a healthy and hard working small business owner, she wants to take care of health care needs in order to be a great parent and role model for her children.

Tragically and remarkably, this bad situation may soon get much worse. While the Medicaid blockade has, despite Gov. Cooper’s recent laudable efforts to overcome it, harmed hundreds of thousands of people like Michelle, the gap will almost certainly widen dramatically if Congress makes good on its threats to replace the ACA. Indeed, as Congress pursues “plans” to replace the significant coverage gains of the ACA with plans that do not account for pre-existing conditions or even making sure there is gender parity for health care, there will be be thousands more moms who are faced with impossible choices regarding their health and well-being.

Happily, all hope may not yet be completely lost. As the debate over ACA repeal continues, more and more states states that have already expanded Medicaid and realized the benefits (many with conservative Republican leadership) are fighting to continue Medicaid expansion as it has benefited thousands of people and state budgets. Let’s hope the logic of this argument finally dawns of North Carolina leaders in the days and weeks ahead.

Commentary

The Medicaid blockade impacts hard working, average North Carolinians

Even though there is court hearing scheduled for Friday to lift the temporary restraining order on Gov. Cooper’s plan to close the coverage gap, leaders at the North Carolina General Assembly want to extend their efforts to block 500,000 North Carolinians from getting health coverage. Yesterday, Senate leader Phil Berger and House Speaker Tim Moore filed court papers inthe case asking the judge to reject Gov. Cooper’s request to lift the temporary restraining order so that veterans, children, parents, and low-wage workers can finally gain access to health coverage. Despite reports of Medicaid expansion’s success, opponents of closing the coverage gap continue to act on their misguided belief that expansion some how dis-incentivizes job seeking and will be costly. In fact, recent reports show that state spending for Medicaid expansion is decreasing just as CMS predicted. What’s more, reports continue to show that 62 percent of adults in the coverage gap belong to families that have either a full-time or part-time worker in their household.

In North Carolina, 56 percent of adults in the coverage gap work for small businesses, like Jerry (pictured at left). Like others in the coverage gap, Jerry is college educated, and like many of us has faced hardships. When he lost his job at a small business, Jerry worked hard to find new employment. He went back to school and even started his own IT business. Unfortunately, lawmakers continue to block Jerry’s path to health coverage. Jerry and thousands like him remain in the coverage gap. They make too little to qualify for financial help to purchase health coverage through the Marketplace and do not meet the eligibility for Medicaid.

The General Assembly’s Medicaid Blockade is harmful. The block on Medicaid expansion hurts real people like Jerry who are working hard to make ends meet and contribute positively to their communities. The Medicaid Blockade prevents hard workers like Jerry from being able to address his chronic conditions like diabetes and sleep apnea so that they can be even more productive. Let’s fervently hope that they legislative leaders changes their minds soon before their policies help to ruin even more lives.