Despite reports from states that Medicaid expansion has had health and fiscal benefits, North Carolina remains in the minority along with 18 other states that have failed to close the coverage gap. Unfortunately, there is still a sentiment that people have to prove that they are deserving of health care coverage, instead of noting how increased access to health care and utilizing health services has positive effects ranging from school achievement to job production. The 2016 Child Health Report also highlights how parental coverage is directly connected to whether children have access to and utilize health care services .
Those who object to expanding Medicaid fail to report that many individuals in the coverage gap are working, but may not work enough hours to qualify for employer-sponsored health insurance. Further, many working adults in the coverage gap have low wage jobs and thus make too little to receive financial assistance to purchase health coverage through the Marketplace. As a family of four in the coverage gap has an income of $33,534, it does not seem that Large Health Savings Accounts (HSAs) are a viable option for families that have other financial priorities.
Failing to expand Medicaid will not only continue to increase health disparities among individuals and families, but also entire communities. The longer policymakers take to close the coverage gap, the more it impacts rural communities’ ability to provide affordable and quality health services. According to the Hospital Strength Index, there are 16 vulnerable rural hospitals in North Carolina. If these hospitals were to close, there would be over 300,000 fewer patient encounters and over 3,000 health care related jobs would be lost. Considering that nearly 30 counties in North Carolina lack primary care providers such as Ob-Gyns, the gap in availability of health services could increase further.
Opponents of closing the coverage gap also cite concerns that individuals that currently obtain financial assistance to purchase health insurance through the Marketplace will shift to “inferior” Medicaid coverage if North Carolina expands Medicaid. However, a report by The Commonwealth Fund, states that Medicaid beneficiaries receive preventative care at the same rate as those with private health insurance. Medicaid enrollees also reported similar rates of satisfaction with their health care experience as the privately insured. What’s more, Medicaid beneficiaries report having medical debt at lower rates than the privately insured. Along with the misperception that people will receive “inferior” care, there is concern there will be increased burden to individuals and families with private insurance through cost-shifting. Overall, Medicaid spending growth is less than private insurance. Additionally, as payment for private insurance and Medicaid services shift from fee-for-service to global payment models, cost-shifting to private insurance beneficiaries is unlikely. Considering that Medicaid reform is transforming to a full risk capitation payment model, this is even less of a concern in North Carolina. Now that North Carolina’s Medicaid program is entering a new phase, it is time to extend Medicaid coverage to 500,000 people in the coverage gap.