No more baby steps: It’s past time for full Medicaid expansion

The landmark Affordable Care Act (ACA) is still young at ten and a half years old and it has been challenged and bullied by conservative politicians across the country. Today, however, it’s clear that the law is here to stay and that many of those same politicians who opposed it now realize how much the ACA has to offer and have fully accepted it. Indeed, one state after another — 38 at this point — has accepted Medicaid expansion after it was made voluntary by the Supreme Court.

North Carolina, however, continues to miss the opportunity. As we miss out on this chance to bring health care to hundreds of thousands of North Carolinians, families across our state are forced to miss out on moments with loved ones lost to the coverage gap.

People like Robin, whose daughter Jessica died from an accidental overdose after not being able to get help for her mental health and substance use disorder issues due to being in the gap.

People like Margie, who lost her brother-in-law Jeff to cancer that was diagnosed too late, because he didn’t have insurance through his job as a cook and wasn’t eligible for Medicaid.

People like those in Deanna’s family, who lost their matriarch because her cervical cancer went undetected, after she lost pregnancy Medicaid coverage when her son was stillborn.

Even in the midst of a health pandemic, state leaders have refused to expand Medicaid — either during the General Assembly’s special COVID-19 sessions or the current “long session.” This has been despite the presence of daily opportunities to pass a bill or include it in the budget that just became law.

This year, it seemed that we were closer than ever before. I was looking forward to sharing the news with Robin and Margie and Deanna’s family that our state’s leaders were finally going to close the Medicaid coverage gap for well over 600,000 Tar Heels.

Ultimately, however, Medicaid expansion — something that, during a pandemic, has saved lives and strengthened communities in expansion states and that would have been accompanied by a minimum $1.7 billion incentive from Congress — has been excluded from the state budget. This critical lifesaving policy that not only connects people to preventative care screenings, helps them fill their prescription medications, and is also a lifeline for rural hospitals, has once again been denied.

Instead, the final budget features an array of missed opportunities and ultimately, a failure to invest and fully support all people and communities, including the same essential workers who’ve been celebrated by the entire state as heroes, but who often don’t receive the compensation and benefits they deserve.

Indeed, in addition to its truck-sized shortcoming when it comes to health care, the new budget also fails to provide full funding for public education that is required by our state constitution (and a court order) or to ensure that wealthy corporations pay their fair share in taxes for the public good.

Sadly, all that I have to share with Robin, Margie and Deanna’s family is that instead of fully expanding Medicaid, lawmakers approved temporary access to care for new mothers and for foster parents to assist with reuniting families. These are mere baby steps that leave us miles still to travel to achieve genuine and truly meaningful Medicaid expansion.

Are there provisions in the budget that will improve lives? Sure. But, there’s nothing about this budget that changes the fact that hundreds of thousands of our friends, neighbors, and small business owners are still stuck in the coverage gap awaiting rescue. Cutting taxes on wealthy corporations will not help us strengthen our communities now or over the long term. People who are the most impacted by poverty should always be at the center of policymaking. The months-long budget process had ample time for public comment, yet the process was shrouded in secrecy and carried on behind closed doors.

Public comment would have revealed what we already know: North Carolinians overwhelmingly agree with Medicaid expansion policy. The state’s deadly coverage gap has now persisted for a decade. It’s been tough for too many far too long.

Advocates for expansion are not, however, giving up. Ultimately, all North Carolinians are in this together so even though this year’s budget doesn’t include Medicaid expansion, we’ll look towards the legislative committee appointed by the General Assembly to get it done next year, once and for all.

Nicole Dozier is the Director of the North Carolina Justice Center’s Health Advocacy Project.

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