This past Saturday, July 30th, marked the 57th anniversary of the passage of the Medicare and Medicaid Act. In our nation’s long, slow march to assuring quality, affordable healthcare for all, this legislation was a significant leap forward at time when a pervasive lack of healthcare access drove tens of millions of working families and seniors deeper and deeper into poor health, poverty and death.
Today, sadly, we still have a long way to go to assure that there is quality, affordable healthcare for all. But we do have an opportunity during the current General Assembly in Raleigh, and current Congress in Washington, to make important progress in this vital area.
All of us concerned about justice and equality need to keep urging our lawmakers to pass two important pieces of legislation: a bill that will expand Medicaid here in North Carolina, and a bill that will close the Medicaid coverage gap in all other states that have not expanded their programs.
Right now in the twelve states that have not expanded Medicaid, more than two million people remain stuck in the Medicaid coverage gap that the Affordable Care Act was designed to close. What’s more, of those twelve, only North Carolina and South Dakota are seriously considering expansion — here through legislative action, and there though a ballot initiative. Expanding Medicaid here in North Carolina would reverse more than a decade of senseless and cruel denial of the health and economic benefits that expansion would deliver.
Unfortunately, in the other 10 non-expansion states, there is no current hope of closing the coverage gap other than through action by Congress.
As a Black woman with two daughters who have serious health problems, but who have been inadequately treated or even made worse because they’re trapped in the Medicaid coverage gap, I feel the injustice and indignity of our state’s failure to expand Medicaid every day. I see the same impact every day in my work as a healthcare organizer and advocate, especially among the Black and Brown women who have advocated with me for expansion through Action NC’s Race and Gender Equity Initiative.
In non-expansion states, two-thirds of people who can’t get access to Medicaid are people of color. People of color are more likely to have low-wage jobs that don’t offer affordable coverage, and one in four people with medical debt in collections is a person of color. It’s hard to believe, but in our rich nation millions of people every year incur medical debt that damages their credit and impedes their ability to get housing, go to school, or provide for their children because they don’t have adequate insurance. States like ours that have not expanded Medicaid have the highest rates of medical debt, which is now the top source of all debt in our country.
It’s plainly unfair that such a disproportionate share of those still in the Medicaid coverage gap are from southern states. This disparity deepens our differences and widens the gap between rich and poor, Black and white, North and South.
Access to healthcare should not depend on zip code, job or income. As the medical debt numbers show, affordable access is vital not only to better health, but also to economic security and stability. Without it, individuals are one sickness, one car accident, or one on-the-job injury from hardship or bankruptcy.
The prospects for passing a federal reconciliation bill that addresses healthcare access, tax fairness and climate change are looking up now that Senators Manchin and Schumer have reached an agreement about what the bill would include. It’s not a done deal, but the exasperation so many of us have felt during this saga has turned again to hope. Disappointingly, it won’t be the bill originally proposed. Whether or not it will provide for closing the Medicaid coverage gap is an open question. If it’s not included, there may be other chances to get it passed this fall in different bills. Either way, Congress can’t give up.
But the best route to coverage in North Carolina is for the state General Assembly to act. Our organization will keep pushing for it, as will many other good groups and the large majority in the state who favor expansion. For other states, we must keep pushing Democrats in Congress to close the coverage gap. Sadly, the unanimous opposition of Republicans in the House and the Senate to the reconciliation bill and all the good it will do, like lowering prescription drug prices, will not change.
During the pandemic, expanding Medicaid eligibility was a vital lifeline provided by the Biden administration and Congress, just as it has been in many other crises from hurricanes to terrorist attacks. There is no principled or fair argument against making this lifeline available to millions of people in need at all times rather than just during emergencies. Now is the time to tell our state legislators, and Representatives and Senators in Washington to do their jobs and pass these bills. My daughters, and millions of deserving people just like them, are counting on us.
Carrol Olinger is the Cumberland County Director of Action NC.