Commentary, public health

New poll: Closing the coverage gap is wildly popular in North Carolina

In case you missed it, 75% of North Carolinians support closing the coverage gap, according to results from a poll commissioned by Care4Carolina — a coalition working to improve health care and expand access in North Carolina. The survey of 612 registered voters, conducted by Harper Polling and The Stewart Group from August 26-27, found that a solid majority want to ensure that more have access to health care, while only 16% oppose. This support is not limited to singular political ideologies as 64% of self-identified Republicans, 76% of unaffiliated voters and 83% of Democrats favor closing the coverage gap in the state.

Amid a global pandemic that has claimed the lives of nearly 200,000 Americans and has infected almost 180,000 North Carolinians, voters in the state continue to recognize the importance of health care access. Most voters see dealing with COVID-19 as the most critical election issue of the 2020 cycle with 61% believing that closing the coverage gap is of significant importance.

Since 2010, the General Assembly has refused to adopt Medicaid expansion, intentionally leaving at least 600,000 of our neighbors without access to quality health care. Even in the midst of a pandemic that has robbed 1.1 million North Carolinians of their jobs, a further 367,000 losing their employer-sponsored health insurance, which pushed 178,000 more into the coverage gap, leaders in the General Assembly have refused to allow legislation to move forward to address this crisis. In fact, during the recent floor debate around HB 1105, Representative Donnie Lambeth, the primary conservative sponsor for closing the coverage gap, proclaimed that the state could not expand Medicaid because the program itself was going through transformation and was broken. This thinking does not seem to square with the rest of North Carolina, let alone his home county. Voters in Senate District 31 (Forsyth and Davie) approve closing the coverage gap 69 % to 26%.

Why do legislators continue to deny expanding Medicaid when voters continue to support it? This past short session addressing state needs around the pandemic was an incredible opportunity to expand Medicaid. Too many North Carolinians are wondering what they would do if they get sick and need access to health care. A $335 check is not going to provide the working mother of one, earning minimum wage, the health care she needs. It is our sincere hope that during an economic downturn caused by a global pandemic that our state leaders would come back to session and do what is right by their constituents. They need to expand Medicaid.

You can find the full poll results here.

William Munn is a policy analyst in the the North Carolina Justice Center’s Health Advocacy Project.

COVID-19, public health

As state nears 25,000 COVID-19 cases, rural NC infection rates are the highest

On Monday, North Carolina reported 24,000 positive COVID-19 cases. Twenty percent of those infections are in the state’s two most populous counties, Mecklenburg (3,403) and Wake (1,478). The country and the state have focused a lot of attention on the virus’s rapid spread in population-dense and urban spaces. This framing, coupled with an initial lack of testing, has created the perception that rural North Carolina has not experienced COVID-19 like the rest of the country.

This is untrue.

In the North Carolina context, it appears that the rural counties have been harder hit. By examining COVID-19 infection and death rates instead of solely infection and death counts, one is able to scale impact relative to county population.  Once viewed through this context, the conclusions change.

The state rate of COVID-19 infections is 229 per 100,000, while the crude death rate is 7.5 per 100,000. Counties classified as rural by the NC Rural Center’s methodology show an infection rate of 257 per 100,000 and a death rate of 8 per 100,000. For comparisons sake, urban/ suburban counties have an infection rate of 204 per 100,000 and a death rate of 7 per 100,000.[1]

While these rate differences are not extreme, several hot spots in rural North Carolina are cause for concern. Duplin and Wayne counties lead the state with 1,121 and 837 COVID-19 cases per 100,000 people.

In terms of crude death rate (deaths per 100,000), Northampton and Vance counties lead the state with 62 and 40 deaths per 100,000, respectively.

These are all rural counties, but the trend does not stop there.[2] The 15 counties with the highest COVID-19 infection rate are rural, and 18 of 20 counties with the highest COVID-19 death rates are also designated as rural.[3]

There are several reasons that rural North Carolina is ill-positioned to respond to a pandemic. After North Carolina refused to expand Medicaid, seven rural hospitals closed, leaving 17 counties without a state-licensed facility.[4]

These same rural counties generally have higher rates of uninsured, making it less likely that people get treated for any disease, let alone COVID-19. Duplin, Greene, Swain, Sampson, Graham and Robeson counties lead the state in the percentage of county population uninsured, further complicating efforts to reduce the cases and spread of COVID-19 infections.[5]

A potential contributor to NC COVID-19 infections in rural North Carolina are occupational trends — how people work in community. In places where economies without a significant number of highly skilled jobs, meat processing plants offer many residents the opportunity to earn a steady income and stability. However, in a pandemic, the close nature of meat processing work creates a liability for the workers, their families and entire communities.

While one would offer caution in arguing that a scientific relationship exists between communities with meat processing plants and COVID-19 infection rates, policymakers should be aware of potential impact.

Last week, NCDHHS announced that 13 counties had meat processing plants with COVID-19 outbreaks.[6] Twelve of the 13 counties are considered rural.

After mapping these communities and the percentage of the county workforce employed in production jobs, four rural county clusters emerge as plausible connections between the concentration of meat processing plants and higher rates of infection per 100,000.

Cluster 1 — Duplin, Sampson, Wayne, Wilson, Lenoir, and Greene
Cluster 2 — Bertie, Northampton, and Halifax
Cluster 3 — Chatham and Lee
Cluster 4 — Wilkes, Surry, and Yadkin. [7]

As the number of COVID-19 cases climb toward 25,000, let us not lose focus on the particular pain rural communities in North Carolina are experiencing. All it takes is a deeper look.

William Munn is a policy analyst with the North Carolina Justice Center’s Health Advocacy Project.

[1] Internal analysis from NCDHHS COVID-19 Dashboard data

[2] Internal analysis from NCDHHS COVID-19 Dashboard data

[3] NCDHHS Dashboard

[4] “A triple disaster: Uninsured, living far from a hospital, and sick with COVID-19”, Lisa Sorg, NC Policy Watch – https://bit.ly/2V1uTaY

[5] Small Area Health Insurance Estimates – https://www.census.gov/data-tools/demo/sahie/#/

6] “N.C. has 23 meat processing plants with COVID-19 outbreaks, more than 1,300 cases” WBTV 3 – https://www.wbtv.com/2020/05/12/nc-has-meat-processing-plants-with-covid-outbreaks-more-than-cases/

[7] Internal analysis from NCDHHS COVID-19 Dashboard data

 

Commentary, COVID-19

Report: uninsured rate will soar in states that have not expanded Medicaid

Percentage of newly unemployed to lose insurance in states like NC will be almost twice the rate of Medicaid expansion states

Between March 15 and April 25, more than 30 million American workers lost their jobs during the economic slowdown caused by COVID-19. [1]

More than a million of those workers are from North Carolina, and while talks of reopening businesses ramp up, there is much uncertainty around how quickly many employees will be rehired or find new jobs. With the occupational environment in a state of flux, some economists predict that the jobless rate could reach 30%. [2] Since most health insurance coverage is tied to employment, such stark job losses are having an enormous impact on North Carolinians’ ability to access health care.

Earlier this month, the Urban Institute and the Robert Wood Johnson Foundation published a report highlighting this issue in very precise and quantitative terms. [3] The authors employed a model that predicted the loss of employer-sponsored health insurance under three national unemployment rate scenarios: 15%, 20% and 25%. While many of the newly unemployed will become eligible for Medicaid or Marketplace coverage with federal subsidies (financial help),  a number of Americans will become uninsured.

In states that have refused to expand Medicaid, the percentage of newly unemployed becoming uninsured is much higher than states that chose to expand Medicaid. The model revealed that in expansion states of the 11.6 million losing employer-sponsored health insurance, 2.6 million or 23% would find themselves uninsured.

In non-expansion states like North Carolina, of the 6 million who have lost employer-sponsored health insurance, 2.4 million, or 40%, could find themselves uninsured. The visualization below illustrates how states measure up when considering ESI loss population eligible for Medicaid and those from the same group now projected to be uninsured.

The decision to refuse to expand Medicaid in North Carolina has had numerous negative implications such as rural hospital closures, the burden of needless uncompensated care, an over-reliance on emergency rooms as primary care facilities, as well as preventing more than 500,000 people from access to quality health coverage. [4]
With the loss of more than 1 million jobs and an estimated 550,000 employer-sponsored health insurance plans, one would think that Senate Leader Phil Berger would consider Medicaid expansion as good policy for North Carolinians. While Berger’s press conference yesterday certainly does not engender confidence that he will change his mind, it is possible that this report’s findings showing North Carolina adding 240,000 to the coverage gap might do so. [5]

Read the report here.

[1] U.S. Department of Labor. News Release: Unemployment Insurance Weekly Claims. Washington: U.S. Department of Labor; 2020. https://www.dol.gov/ui/data.pdf.

[2] Matthews S. U.S. unemployment rate may soar to 30%, Fed’s Bullard says. Bloomberg. March 22, 2020. https://www.bloomberg.com/news/articles/2020-03-22/fed-s- bullard-says-u-s-jobless-rate-may-soar-to-30-in-2q.

[3] How the COVID-19 Recession Could Affect Health Insurance Coverage – https://www.urban.org/research/publication/how-covid-19-recession-could-affect-health-insurance-coverage/view/full_report

[4] Ku L, Bruen B, Brantley E. The Economic and Employment Benefits of Expanding Medicaid in North Carolina: June 2019 Update. Washington, DC: Center for Health Policy Research, The George Washington University; 2019. http://www.ncpolicywatch.com/wp-content/uploads/2019/06/Expanding-Medicaid-in-North-Carolina-final.pdf.

[5]  Under 20 percent unemployment scenario

William Munn is Policy Analyst with the N.C. Justice Center’s Health Advocacy Project.

Commentary, COVID-19

Report: African Americans are contracting and dying from COVID-19 at higher rates. We know why.

[Editor’s note: The following is the executive summary from an important new report on the impacts of the COVID-19 pandemic that was released last week by the North Carolina Justice Center’s Health Advocacy Project. Click here to explore the full report.]

African Americans are disproportionately contracting and dying from COVID-19.

  • Data from states such as Michigan, Illinois, New York, Alabama and Louisiana show that the percentage of African Americans who have been diagnosed with and died from COVID-19 is considerably higher than their representation as a percentage of the population.
  • If current trends hold, 162 African Americans will die from COVID-19 in North Carolina—70 more than would be expected to die based solely on the state’s demographic makeup.

Historical discriminatory policies and practices, as well as the nation’s failure to value its “essential workers,” have put African Americans at greater risk.

  • African Americans are more likely than white Americans to work jobs — even multiple jobs — that do not offer health insurance. Many of these workers fall into the “coverage gap,” meaning they earn too much to qualify for Medicaid and too little to qualify for financial assistance under the Affordable Care Act.
  • African Americans are overrepresented in occupations now deemed essential to the well-being of the nation, such as food service, food production, home health care and nursing home care. These jobs put the people who work them at higher risk for contracting the coronavirus.
  • Neighborhoods and counties with high populations of people of color have fewer health care providers and grocery stores, as well as lower air and water quality due to the legacy of environmental discrimination. As a result, African Americans have a higher rate of conditions that make COVID-19 more deadly, such as diabetes, chronic lung disease and hypertension.

State lawmakers should immediately approve Medicaid expansion, which would reduce African American deaths from COVID-19 and long-term measures to improve the health of African American individuals and communities.

  • Approving Medicaid expansion is the most impactful step North Carolina lawmakers can take to both protect African Americans from the lethal effects of COVID-19 and improve the health and resiliency of African American communities, making them better able to combat this and future outbreaks.
  • Expanding Medicaid would provide a much-needed financial boost to rural hospitals, which currently face high costs for uncompensated care, and improve the health outcomes of rural communities.

Click here to explore the full report.

NC Budget and Tax Center

New data: Economy continues to leave rural areas behind

While much attention is being paid to the September national and state unemployment rates of 3.3 percent and 3.5 percent, one risks overlooking serious regional challenges that undermine the broader prosperity of North Carolina as a whole. September’s local and metropolitan labor market report revealed that 77 counties in North Carolina with unemployment rates the same or higher than September 2018, 51 counties with rates higher than the state unadjusted average, and 42 counties that have lost jobs since December of 2007.

Rural, eastern North Carolina is over-represented in this group of economically distressed communities. In fact, 26 of the 42 counties that have lost jobs since the beginning of the Great Recession are from these county groupings. The northeastern part of the state is host to a group of counties – Vance, Warren, Halifax, Edgecombe, Wilson, and Hyde – whose unemployment rates are all nearly 2 percentage points higher than the state’s September average. Also, counties on the state’s southeastern border with South Carolina – including Richmond, Scotland, Hoke, Cumberland, Robeson, Bladen, Columbus, and Brunswick counties – all have jobless rates at least one percentage point higher than the state average.  

In addition to the state’s highest regional concentration of high unemployment, eastern NC counties make up 26 of the 42 counties that have lost jobs since the beginning of the Great Recession. Three of the four are “Double whammy” counties: those that have jobs since December of 2007 and year-over-year are in the eastern part of the state. Martin, Vance, and Washington counties have lost nearly 6,500 jobs since the beginning of the Great Recession, a loss of 18 percent of the nearly 36,000 jobs combined from 12 years ago.

As the end of 2019 approaches there is no question that after 12 years the state has not recovered equitably. Too much of rural North Carolina is mired in economic distress that is not happening in many urban spaces. This imbalance leaves the entire state, and particularly rural communities, exposed to collective harm caused by natural disasters and economic downturns.

Will Munn is a Policy Analyst at the N.C. Budget and Tax Center.