North Carolina lawmakers have so far rejected federal money to expand Medicaid and provide health care to up to 600,000 struggling adults.
Renita Webb wakes up every day worried.
Terrified she could have a fluke fall, leaving the Alamance County mother of four with a doctor’s bill she can’t pay. That her underlying health conditions could flare up and a hospital bill would come that would mean the mortgage would go unpaid.
Even trips to the grocery store during the COVID-19 pandemic are scary. Not just because of the virus itself, but knowing that Webb also can’t afford to get sick.
“Health insurance access should not be a privilege, but it most definitely is,” Webb said
There’s just no other options for her to get coverage right now, with any plans sold on the private marketplace out of her family’s reach, and no subsidies available because of a fluke where those that make too little, don’t get help.
“You can get caught in the gap like we do, where we make too much to get full Medicaid but we make too little to be approved for true coverage.,” Webb said. “Then we just have to make choices.”
This is life in the health insurance gap, a reality for an estimated 600,000 North Carolina adults, many of them working, who are without health insurance and no way to afford it on their own.
Hardest Hit in NC’s Rural Counties
Black and Latino North Carolinians, especially those in rural areas, are less likely to have insurance. So hundreds of thousands wake up every day like Webb, just hoping they can put off health services they need.
That’s because North Carolina is one of just 12 states that haven’t taken up the offer of federal funding to expand Medicaid through the landmark Affordable Care Act championed by former President Barack Obama.
In the 38 states that have done it, scientific studies have shown things have improved on many fronts: people were more likely to detect various types of cancer in earlier stages, smokers were more likely to try to quit, babies had better outcomes, and costly emergency room usage went down, a sign that people had avenues and the means to go to primary doctors.
Among the Southeastern neighbors that have opted to expand Medicaid: Kentucky, Virginia, West Virginia and Louisiana, according to the Kaiser Family Foundation, a nonpartisan group that tracks health policy issues.
Here’s who wants North Carolina to expand Medicaid: Gov. Roy Cooper, rural, business leaders and rural hospital operators who warn the state may lose even more of its rural hospitals if there’s not a way for the poorest North Carolinians to pay for their health care.
And North Carolinians want it as well. Three out of four voters say they want to expand Medicaid coverage to those who can’t afford healthcare on their own, according to a September poll put out by a Care4Carolina, a coalition of dozens of NC nonprofit groups, healthcare providers and business leaders pushing to expand health care access.
So, why doesn’t North Carolina take steps to help its uninsured? The resistance is anchored at the offices of Republican members of the N.C General Assembly, who control the state legislature.
In the past, Republican legislative leaders have said it’s a fear that the state could be on the hook years down the road for some of the costs of the program that was a signature piece of President Obama’s Affordable Care Act.
Now, people around the state are hoping a provision in the American Rescue Plan for the federal government to pay for more of the existing Medicaid plan incentivizes states such asNorth Carolina, which could save $1.7 billion over two years in exchange for expanding the program to people like Webb. The state is about to switch much of its $15 billion Medicaid system this summer to a new privatized system as well.
“This would bring in a lot of money to the state,” said Hyun Namkoong, a policy advocate with the NC Justice Center, which advocates for those in poverty, about the American Rescue Plan.
A new group, Southerners for Medicaid Expansion, estimates the state has left $38.2 billion in federal money on the table by rejecting Medicaid expansion so far.
“It’s a great time for us to be able to save billions of dollars and transform the system, and then also be able to add a lot of folks,” she said.
Advocates with Southerners for Medicaid Expansion is urging North Carolina and seven other states to speak up to their elected officials about health care access, and believes North Carolina lawmaker’s decision to reject Medicaid expansion has left 648,000 people without health care, 48% of who are Black, Hispanic, or from other marginalized groups.
Representatives from state Senate leader Phil Berger, an Eden Republican, declined to comment to Cardinal & Pine for this article about whether that sweetens the deal for them enough. The communications officer for state Rep. Tim Moore, a Kings Mountain Republican, didn’t respond to a request for comment.
State Sen. Gladys Robinson, a Guilford County Democrat who used to run community health centers herself, introduced a bill to expand Medicaid again this year, as she has in the past. But she’s hoping this year more of her Republican colleagues will support it, or at least be willing to negotiate so that those without health insurance can get the help they need.
Not expanding Medicaid, she said, is hurting people in the state who are trying each day just to get ahead, or just stay afloat.
No Time to Wait
For people like Webb, it is way past time to help.
Webb and her husband, a military veteran, have four children. The eldest two are grown, and out of the house, while their youngest, ages 10 and 3, live in the family home in Alamance County. He gets coverage from the Veterans Administration, her youngest children through Medicaid.
She, alone, is left without insurance in the family right now. A lifetime educator with three degrees, this is the first time Webb has been without insurance since 2018 when she left teaching to take on a job managing after-school programs. She works 35 hours a week, but because the non-profit has less than 50 employees, it is not required to offer her insurance.
“I still fell into this coverage gap,” Webb said. “It is easy to get here, but it’s not easy to get out.”
She’s had health issues where doctors have wanted her to come in for follow-up treatments, but she can’t afford to.
That’s why she’s speaking up and wants more to as well. Call your lawmakers, or email them to explain what it’s like to not have health insurances, she said.
[To find out how to email or call your elected state representatives and senators, click here.]
Or just talk to friends and family and others about it.
The shame of being without insurance isn’t one that individuals should carry, Webb said, but more for those in power who are standing in the way of helping their fellow North Carolinians.
North Carolina pays for all members of its state legislature, who only meet part-time, to have health insurance if they want it.
That, Webb said, is unfair and means they have no way of understanding the constant stress and worry those like her live with.
“I feel like I’m not seen, heard or cared about,” Webb said, because of the way lawmakers have stood in the way of Medicaid expansion.
Her suggestion: They should go without like she does. And then make a decision about whether North Carolina should opt to extend health coverage to others.
“If they’re going to make this decision, then they should have to walk a year in the coverage gap,” she said.
By the end of the year, she predicts, the decision would be clear. The time is now for North Carolina to expand its Medicaid program.