VetHealthNorth Carolina ranks 8th for veteran population as there are nearly 800,000 veterans living in the Tar Heel state. The VA reports that in 2014 there were four VA Hospitals, six Vet Centers, and sixteen community-based outpatient clinics throughout the state. Given the veteran population, it is easy to see why the VA Secretary, Robert McDonald, has reported much difficulty in meeting demands for veteran health care with limited resources and facilities. In North Carolina, only 321,459 veterans are enrolled in the VA Health Care System and only 214,215 patients were reported as treated in North Carolina in 2014.

Further, 316,000 veterans are aged 65 years and over and thus qualify for Medicare, which makes it easier to access health care outside of the VA Health Care System. Unfortunately, there are too many veterans that have difficulty accessing care and with statistics showing that one out of every ten veterans under age 65 years do not use VA health care and do not have health insurance shows that the United States has much room to improve how we care for those who have served this country. Fortunately, with the passage of the Affordable Care Act (ACA), a pathway did open to make health care to veterans more affordable and accessible. The pathway is Medicaid Expansion. Research has shown that four out of every ten uninsured veterans fall into the Medicaid coverage gap. This means that many veterans and their spouses make too much money to qualify for Medicaid (note: there are additional criteria for Medicaid eligibility) and too little to qualify for financial help or subsidies to enroll in the ACA through the Marketplace.

A report by the Robert Wood Johnson Foundation that used data from the 2008-2010 American Community Survey, show that there are approximate 23,000 veterans in North Carolina that would benefit from Medicaid Expansion. Approximately, 8,000 spouses of veterans would also be able to access affordable health care if North Carolina expands Medicaid. So as we honor those who have fought and served our country tomorrow, let’s not forget that North Carolina has an opportunity to protect our veterans and their families’ health by closing the coverage gap. As Medicaid reform moves forward, our policymakers can include Medicaid expansion so that veterans’ mental and physical health is protected.


Action NC policy and public affairs director Kevin Rogers has an opinion piece in the News & Observer arguing that the ACA is here to stay, so we should get down to the business of improving the law and fully implementing it in North Carolina.

Open enrollment, he reminds us, starts November 1. Our state is a national leader when it comes to signing up residents for Affordable Care Act plans. The many people who have these policies need added protections, not repeal votes, to make their insurance plans work better. And the working poor need our state leaders to stop blocking Medicaid expansion. This interposition is causing great pain, and unnecessary deaths, all across North Carolina.

You can read the entire editorial here. Rogers concludes with this message to lawmakers:

As we enter the third ACA enrollment period, it is high time for Congress and the General Assembly to accept reality, abandon partisan tricks and move forward to improve the economic and human well-being of our state. Until then, thousands of lives will be lost each year, and billions of dollars wasted that health care consumers, taxpayers and our government cannot afford. The ACA is here to stay – it’s time to start acting accordingly.

If they heed his advice that would be sweet indeed.


In addition to extending health care coverage to nearly a half million people, creating over 40,000 jobs by 2020, and preventing nearly 15,000 families from facing catastrophic medical bills annually, new data from the Kaiser Family Foundation shows that Medicaid expansion actually helps slow state Medicaid spending growth.

A survey of Medicaid directors in all 50 states showed that Medicaid expansion states only saw a 3.4 percent increase in state Medicaid spending growth compared to non-expansion states like North Carolina that experienced on average a 6.9 percent increase in state spending growth. What is more, Medicaid expansion states were still able to control Medicaid spending growth despite Medicaid enrollment increasing by 18 percent.

State spending growth in expansion states is less because the federal government continues to cover 100 percent of Medicaid costs through 2016 for expansion states. Starting in 2020, the federal government‘s contribution will remain at 90 percent. For non-expansion states, the federal government contributes much less. For example, the contribution from the federal government for Medicaid only increased 0.36 percentage points from 65.88 percent in fiscal year 2015 to 66.24 in fiscal year 2016. With only a slight increase in federal support for Medicaid, North Carolina will have to spend more as Medicaid enrollment continues to grow. The average monthly Medicaid and CHIP enrollment before the ACA was 1,595,952 and in July 2015 enrollment was reported at 1,911,334 individuals. Considering that there is a 20 percent change in Medicaid enrollment growth, North Carolina policymakers, especially our governor must develop a plan to address Medicaid spending and enrollment growth.

This past legislative session, the legislature passed a short-sighted Medicaid Reform bill that is supposed to increase budget predictability and control costs. More specifically, the bill states that North Carolina’s “risk-adjusted cost growth for its enrollees must be at least two percentage (2%) points below the national Medicaid spending growth…”. However, failing to expand Medicaid and rejecting $2 billion dollars in federal funding annually will act as a major barrier to decreasing spending growth below the national average.

But, it is not too late for North Carolina to expand Medicaid to help control spending growth. A Medicaid expansion plan that is tailored to meet North Carolina’s needs can be added to the Medicaid reform plan waiver that will be submitted to the federal government. In other words our state can reform and expand Medicaid at the same time. These data prove that our state policymakers can no longer use the excuse that Medicaid expansion burdens state budgets. If anything, failing to close the coverage gap through Medicaid expansion strains North Carolina’s budget.


The following is a press release from our friends at ActionNC about powerful polling that shows most voters in battleground states want to move on from the obsession with repealing health reform to a mature discussion of how to improve the law. After more than five years the Affordable Care Act is getting some age on it, and we have learned important lessons from implementation. But we can’t make the law better if lawmakers don’t first accept that it’s a law that is here to stay. As usual, the public has to lead our leaders.


October 7, 2015

Contact: Kevin Rogers, 919.862.4009

Survey Shows that Voters Believe “ACA is Here to Stay”
Elected Officials Need to Improve Law; Not Repeal It

(Raleigh, NC) — A new survey shows that the majority of likely voters in five key battleground states – Florida, Nevada, Ohio, Pennsylvania and Virginia – believe the Affordable Care Act is here to stay (64%) and that Congress should work to improve the law (71%).

The survey, which was released by Community Catalyst and Service Employees International Union (SEIU), found that likely voters prefer a candidate who will work to improve the law over one who would repeal it (55% vs. 40%). Most agreed elected officials should “stop wasting time” trying to repeal the law (58%) and instead focus on a variety of improvements to lower the cost of care.

“These research findings confirm what we continue to hear over and over across North Carolina. People are frustrated with repeated efforts to repeal the ACA. It’s time to recognize that the law is here to stay.” said Kevin Rogers, Policy Director for Action NC. “We need to move forward to find ways to continue to lower health care costs for people and address issues such as high copayments and escalating drug prices.”

“Voters understand that the law has led to some important outcomes such as guaranteeing coverage for people with pre-existing health conditions. This research shows that they now want their elected officials to work together to make improvements that favor patients over insurance companies and pharmaceutical companies,” said Rogers.

The survey showed strong support across party lines for improvements that are being considered to lower health care costs, including:

  • Require hospitals and other health care providers to be transparent about their prices so people understand what the cost of services will be before they use them (75% strongly support)
  • Change the way insurance companies pay doctors and hospitals to create incentives to keep people healthy rather than paying providers based on the number of tests and procedures they give (64% strongly support)
  • Give Medicare the power to negotiate drug prices (63% strongly support)
  • Expand tax credits to small businesses to help the afford employee health insurance (61% strongly support)
  • Give state insurance commissioners more authority to push back on insurance companies that want to hike up insurance premiums (57% strongly support)

The survey was conducted by PerryUndem Research/Communication September 15-19, 2015; 1,005 adults who said they were likely to vote in the 2016 elections and have a history of voting in the 2012 or 2008 elections responded. The margin of error is +/- 3.1 percentage points.

You can read more about the poll results here.


North Carolina’s uninsured rate fell in 2014 thanks to the implementation of federal health reform but data released today show our state is leaving many citizens behind by refusing to expand Medicaid.

The Census Bureau today released the country’s official data on health insurance rates, which shows that 1.27 million North Carolinians lacked health insurance in 2014 compared to 1.5 million uninsured North Carolinians in 2013. Expanding Medicaid would have resulted in a more dramatic drop in the uninsured rate.

We see that many of the states that expanded Medicaid such as West Virginia and Kentucky now have single-digit uninsured rates whereas North Carolina’s uninsured rate was 13 percent in 2014 compared to 15.6 percent in 2013. The Affordable Care Act is working, but it would work better if policymakers stopped blocking coverage for the working poor families who don’t earn enough to buy private insurance and don’t currently qualify for Medicaid.

A study by George Washington University released last year shows that expanding Medicaid in North Carolina would extend coverage to 500,000 more people while creating 43,000 jobs and attracting $21 billion in federal funding over five years.

Nationally, the Census data show that the uninsured rate dropped to 10.4 percent last year, down from 13.3 percent in 2013. These numbers reflect individuals who were uninsured throughout the year. The Affordable Care Act helped more than 8.8 million people gain health insurance coverage.

It’s not too late for North Carolina to catch up with the rest of the nation. The Governor could propose, and the legislature could adopt, a state-specific plan to close the coverage gap at any time.