The wonks at the Center on Budget and Policy Priorities are out with a new and powerful report today on the increasingly-evident benefits of Medicaid expansion. Here’s the lead:

“In the short time since states have been able to expand Medicaid to low-income adults under health reform, a clear divide has emerged between states that have expanded Medicaid and those that have not. Since the major coverage provisions of the Affordable Care Act (ACA) took effect in 2014, insurance coverage rates have improved across the country, but the gains are far greater in the states that have expanded Medicaid. As a result, hospitals in expansion states are treating fewer uninsured patients, and the amount of uncompensated care they are providing is declining steeply. Moreover, contrary to critics’ claims that Medicaid expansion is financially unsustainable for states, there is increasing evidence that expansion has saved states money, and these savings are expected to grow over time.

The Medicaid expansion has had an especially dramatic impact in Arkansas and Kentucky, which both had high uninsurance rates and limited Medicaid eligibility for non-elderly adults before health reform. Both states’ uninsurance rates have fallen by half in just over a year, and the expansion is expected to save each state more than $100 million by the time their current state fiscal years end on June 30.

Meanwhile, the states that have not expanded Medicaid are falling further behind. In the non-expansion states, large numbers of low-income people remain uninsured and without access to affordable health coverage. These individuals are caught in a ‘coverage gap’ because their incomes are too high for Medicaid but too low for subsidies to purchase coverage in the marketplace. Hospitals in these states continue to provide large amounts of uncompensated care, and the states are missing the opportunity to leverage billions of dollars in new federal funding through the Medicaid expansion.”

Click here to see the numbers and read more details about how North Carolina continues to fall farther behind as the result of its stubborn and self-destructive refusal to expand the program.


Nicole and LindaTomorrow is Women’s Advocacy Day at the North Carolina General Assembly and there are a lot of good reasons for caring women (and men) to attend. The one at the top of my list will be Medicaid expansion – the long-neglected plan to extend decent, affordable health coverage to hundreds of thousands of North Carolinians.

As has been explained repeatedly in countless places in recent months, North Carolina would benefit greatly from Medicaid expansion. The numbers of lives that would be saved and the amount of money that would flow to the state are both huge and more than reason enough for state leaders to act. As a group that has long endured lower pay and benefits, women would also benefit disproportionately from expansion.

For me, however, the motivation for speaking out goes well beyond the numbers. It’s also about speaking out on behalf of people who I know and care about – people like my friend, Linda Dunn (that’s us on the left at the General Assembly last month).

I met Linda back in December at a community forum in Kinston at which Sen. Don Davis, Lenoir County Sheriff Ronnie Ingram and several other community leaders expressed concern about the failure to expand Medicaid and the fact that, in Lenoir County alone, expansion would cover 2,270 residents and create more than 350 desperately needed jobs.

Linda attended the forum along with her adult daughter. I met them just before the discussion was set to begin. She was terribly concerned about her daughter’s lack of access to insurance and medical care.

In fact, she was so concerned that she was later inspired to travel to Raleigh to share her family’s story during last month’s Medicaid Expansion Advocacy Day. Linda held onto the podium in the Legislative Building press room while some in the audience held back tears as she spoke like only a mother could about the devastating impacts of suffering from chronic health conditions without insurance. Read More


Medicaid expansionThanks to a report from the American Mental Health Counselors Association, North Carolina along with other states that have not expanded Medicaid have yet another feather to place in their caps – denying access to mental health care for nearly 600,000 uninsured adults that would have sought care last year. Approximately 21,000 of those uninsured adults reside in NC. Even before the debate over Medicaid expansion began, there was the Mental Health Parity and Addiction Equity Act, which has produced a slow push to lessen the gap between how people access and utilize physical and mental health care. Even with mental health parity, over 50 percent of adults with a mental illness did not receive mental health care in NC between 2009-2013. Failing to extend health coverage to individuals with mental illness through expanding Medicaid only increases barriers to treatment, which in turn creates social, physical, and economic burdens to those with mental illness, their families and even their communities.

On the individual level, people living with mental illness are more likely to have other physical chronic conditions, have shorter life expectancies, are poor, and have difficulty finding employment. Students with mental illness, especially those who receive special education, experience school failure and drop out more frequently than other students including students in other disability groups . Without affordable mental health treatment, people with mental illness do not receive preventative treatment and thus rely on costly emergency room visits or even end up in jail.

The families of individuals with mental illness also face burdens as they become caregivers and help pay for expensive out-of-pocket mental health treatment. Unfortunately, the impact on communities resulting from traumatic events like Sandy Hook and Newtown have become too familiar that even the NRA supports policy to enhance the mental health system. On the broader economic level, the National Alliance on Mental Illness reports that the US loses $193.2 billion annually due to lost earnings associated with the sequelae of mental illness.

Treatment received from the public mental health system is especially important as people with mental illness live closer to the poverty line and have unstable employment status. For adults between ages 21 and 64 years that received mental health treatment from the public mental health system, 75 percent were unemployed. For all adults over age 18 that received treatment in the public mental health system, 76 percent reported improved functioning as a result of care. The statistics on employment and mental health may lead some to believe that expanding Medicaid will act as another “handout,” but most adults with mental illness want to work, but lack support to maintain employment. Further, some jobs obtained by adults with mental illness may not offer health care coverage or pay enough to cover out-of-pocket costs. Last year, in states that expanded Medicaid, there were nearly 350,000 fewer people that experienced Major Depression. Hopefully NC legislators will help decrease the burden of untreated mental illness by increasing mental health parity through Medicaid expansion.

Poverty and Policy Matters

There are few situations in life that are clearly win-win. When you see one, you have to take advantage of it.

That’s why North Carolina should reverse course and expand Medicaid. When you have the chance to improve health care for hundreds of thousands of people and actually save money, you should jump on it.

In a recent News & Observer editorial, the paper called the decision not to expand Medicaid “wildly irresponsible and hugely expensive.” That’s precisely correct, and let’s explore the first part of the statement a bit more.

Turning down Medicaid expansion turns down $50 billion in federal funding and prevents roughly 400,000 of our neighbors from getting covered. That makes expanding Medicaid an obvious choice.

But also consider that preventative care saves money over the long run. Insuring people means they get to go to the doctor, which means we pay less to prevent disease. This leads to lower costs for taxpayers and better lives for our people. An excerpt from the N&O piece:

Community Care said in a news release: “The medical costs for low-birth-weight babies average $49,000 in a baby’s first year of life, or more than 10 times more than babies born without complications. A low birth weight also increases a child’s risk for long-term medical and developmental complications and the likelihood of incurring additional expenses for social services and educational needs in later years.”

Kate Berrien, manager of Community Care’s pregnancy project, said North Carolina now leads the South in having the fewest births before 39 weeks. That’s a lot of savings and a vast increase in the quality of life for many children born to low-income mothers. And it’s an achievement attributable to innovations in community-level care that were developed in North Carolina and are being adopted across the nation.

It’s a win-win situation. Tom Wroth, CCNC’s chief medical officer, said, “We’ve been able to align improving clinical quality with lower cost.”

Read that last paragraph again. Improving quality care with lower cost is a win-win. So is expanding Medicaid.


Rural hospital closuresWalking not only has individual health benefits, but this exercise can impact the health of an entire community. For the second straight year, Mayor Adam O’Neal of Belhaven is walking to save lives. While Belhaven is home to approximately 1600 people, Vidant Pungo Hospital provided critical care to people throughout Beaufort County and other rural eastern NC counties. Without the hospital, people face additional barriers to accessing care such as taking time off work to travel close to 60 miles round-trip to see a medical provider.

Beaufort County residents are not the only people in rural communities that have difficulty accessing care as 48 rural counties in NC have shortages in primary care. The closings of rural hospitals is a national issue – The Sheps Center at UNC notes that since January 2010, 50 rural hospitals have closed and nearly 300 more rural hospitals around the country are in danger of closing in 2015.

This year’s walk to DC is even more critical as our state faces many decisions that impact rural health –one of which is whether to repeal NC’s “Certificate of Need/ CON” law to allow for a “free market” and to “reduce costs” associated with accessing health care. However, research has shown that residents in rural communities have fewer resources to pay for health care, so it is unlikely that in a “free market” the need for health care services would go to rural counties where residents are more likely to be uninsured. Thus, there is more likely a duplication of services in urban counties. Further, there is research suggesting that states with CON laws report less hospital inefficiency and can even help reduce the length of stay in emergency departments. This new legislation will create more barriers to accessing quality health care in rural communities.

A second hot topic regarding health care is Medicaid expansion. There are many states that have expanded Medicaid either as outlined in the ACA or that have tailored expansion to meet their state’s needs through waivers. Even though states like Kentucky, West Virginia and Arkansas are seeing health and financial benefits, Gov. McCrory has delayed taking action on this issue until a decision has been made on King v. Burwell by the Supreme Court. The longer lawmakers take on extending health care to 500,000 North Carolinians, the more a financial and health hit our state takes. This is especially true for the rural counties in NC. In Beaufort County, over 1500 individuals would gain access to health care if Medicaid is expanded. However, with the hospital in Belhaven closed, where will the residents go to establish a medical home? Will hardworking residents in our rural counties seek primary and preventative care if there are too many barriers to accessing coordinated care or will they wait for more costly emergency care? Just like repealing or tweaking NC’s CON law, refusing to expand Medicaid affects hospital closures and thus increases health disparities.

If you can, please join Mayor O’Neal and walk for the health of Belhaven and all residents in rural communities whose health is negatively impacted by hospital closures. If you are unable to walk, call our Governor to push for Medicaid expansion and keeping our CON law.