NC Budget and Tax Center

Under flawed House health bill, hundreds of thousands will remain without health care

The NC General Assembly has scheduled House Bill 655 known as NC Health Care for Working Families for a committee hearing this morning. This extremely flawed attempt at closing the coverage gap contains harmful provisions such as work reporting requirements and premiums that have been proven to be ineffective in other states. In the case of work requirements a federal court has deemed this provision illegal. Rather than pursuing a proposal that contains these provisions, the full benefits of Medicaid expansion could be achieved immediately and improve the health and well-being of those North Carolinians currently without affordable, quality health insurance.

Here is what the research tells us:

A recent study on Arkansas work requirements found that work reporting requirements prevented people from accessing health care while doing nothing to boost employment.

  • The percentage of uninsured adults ages 30 to 49 increased from 10.5 percent to 15 percent. During roughly that same time period employment for that same group declined from 42.4 percent to 38.9 percent.
  • Due to massive amounts of red tape and administrative burdens, many working Arkansans were unjustly denied health insurance.
  • Although 97 percent of people subject to the requirements were already meeting the work and community engagement requirements prior to the policy taking effect. Meanwhile, 100 percent of people who failed to report because they thought they had not satisfied the requirements had, in fact, satisfied the requirements.

A study by The Kaiser Family Foundation found that premiums in Medicaid created barriers for low-income families accessing care, especially those living below the poverty line who need help the most.

Estimates of the impact of these two provisions in North Carolina demonstrate that they will block efforts to close the coverage gap.  Specifically, our report released earlier this year conservatively estimated that 88,000 North Carolinians would not be able to meet the work reporting requirements while 145,000 would either lose access to health care coverage or not enroll due to the premiums.  These losses would hold back the health, fiscal and economic benefits of expansion for the state as a whole.

From fiscal policy to administrative efficiency, there are a plethora of reasons why work requirements and premiums are a bad idea. But ultimately, these provisions undermine the goal of closing the coverage gap and creating healthy communities.

Brian Kennedy II is a Public Policy Analyst for the Budget & Tax Center at the N.C. Justice Center.

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