The overwhelming majority of Americans falling into the Medicaid coverage gap are in the South. Due to the obstruction of politicians like those running the show in North Carolina, millions of people who could be insured at federal government expense must instead do without. The scandalous result: thousands of preventable deaths each year.

As Alex Zielinski at Think Progress explains, however, there are some new and encouraging signs that cracks in the obstructionist wall are starting to show:

Red States Begin To See The Light On Medicaid Expansion

Conservative leaders may be warming up to Obamacare’s optional Medicaid expansion — a program that has been traditionally gridlocked in GOP-led states — in an emerging trend that could have a serious influence on the program’s adoption in fellow red states. Recent state elections unveiled a majority of these changes.

At first, many voters in favor of Medicaid expansion feared the recent elections would worsen their chances. And with a new, staunchly anti-expansion governor elected in Kentucky and a unwavering Republican majority in the Virginia Senate, it’s clear why. But these potential road blocks to further state expansions may be countered with other unexpected victories in other states.

The biggest surprise came out of the Louisiana election, where Democrat John Bel Edwards won the governor’s race by a landslide this weekend. He’ll fill the seat of current Governor Bobby Jindal, who has rejected the “subpar” Medicaid expansion program from its start. Edwards is a true Southern Democrat — he’s openly against abortion and gun control — but stands firmly behind progressive health care and labor plans. He’s already pledged to sign an executive order authorizing Medicaid expansion on his first day in office. This would provide immediate coverage to an additional 225,000 uninsured residents.

Meanwhile, in Kentucky, Governor-elect Matt Bevin may be softening his opposition to this Obamacare provision. During his campaign, Bevin spoke firmly about his opposition to Medicaid expansion — which already exists in the conservative state. But now that the election’s over, he’s mentioned a scaled-back attack on the expansion program. Instead of cutting off the 400,000 people who benefit from the state’s Medicaid expansion, he may work with the feds to just adapt it to his liking. This will likely still shed some benefits of the current state program, but won’t affect its users as harshly as predicted.

Kentucky’s expected action — or inaction — may have inspired an unprecedented move toward expansion in a fellow red state, where no Democrat holds a political office: Alabama. Read More


Don’t miss the next N.C. Policy Watch Crucial Conversation luncheon:

Closing the health coverage gap for North Carolinians living with substance use disorders
Featuring Dr. Lonise Bias of the Len and Jay Bias Association and Jeff Matkins of Insight Human Services.

Click here to register

North Carolina, along with every other state, has an unprecedented opportunity to expand health coverage to its most vulnerable residents. Currently, 30 states plus the District of Columbia have broadened Medicaid eligibility with financing available from the Affordable Care Act. So far, legislators in North Carolina, along with the Governor, have blocked these federal funds from expanding access to health care, boosting the state’s economy and bolstering rural hospitals.

Closing the health insurance coverage gap in North Carolina would provide better access to medical services and treatment for 500,000 working poor families. Many of the people locked out of the system have treatable, chronic diseases. An estimated 150,000 are living with substance use disorders. Millions in our state are in long-term recovery from addictions and need ongoing support to remain healthy.

Join us as we discuss these and related issues with two very special experts on the subject:

Dr. Lonise Bias

Dr. Lonise Bias is the Founder and President of the Len and Jay Bias Foundation. Through her pain at the loss of two sons, Dr. Bias has created youth and family programs to reclaim the community and has inspired thousands. She will share her story with us about her son, Len Bias’ tragic death of cocaine intoxication in June 1986 just two days after being drafted by the Boston Celtics.

Jeff Matkins

Jeff Matkins, Chief Operating Officer of Insight Human Services (formerly known as the Partnership for a Drug Free NC), works with colleagues in 60 counties to provide substance use prevention, intervention and treatment. Jeff will discuss how sound policy decisions such as Medicaid expansion would help provide access to care and improve the lives of thousands of North Carolinians.

Click here to register

When: Monday, November 30, at noon — Box lunches will be available at 11:45 a.m.

Where: Center for Community Leadership Training Room at the Junior League of Raleigh Building, 711 Hillsborough St. (At the corner of Hillsborough and St. Mary’s streets)

Space is limited – pre-registration required.

Cost: Thanks to a generous donor, admission is FREE and includes a box lunch. Donations, however, are welcome.

Questions?? Contact Rob Schofield at 919-861-2065 or

Click here to register


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.