A key policy that Americans seek to hear about from their elected officials is their stance on healthcare — and for good reason. In 2016, average American spending on healthcare reached another all-time high of $10,345. For most people, healthcare is an unavoidable expense that just keeps rising.
While we are still a long way away from being universal beneficiaries of social welfare programs like Medicare for All, Medicaid is still a large and impactful program. Established in 1965 by President Lyndon B. Johnson, Medicaid supplies healthcare access to millions of struggling Americans of all ages unable to afford insurance. Most Medicaid recipients are single parents, children, people with disabilities, low-income seniors or low-income pregnant women.
North Carolina House Democrats and Gov. Roy Cooper are stepping in the right direction with their proposals to expand Medicaid access. Their proposal would make individuals living within 138% of the federal poverty line eligible for Medicaid. This push to expand access could provide healthcare for around 300,000-500,000 North Carolinians.
Medicaid expansion is perhaps the most beneficial in states like North Carolina, where large swaths of our state are rural areas. Rural counties are often inhabited by many citizens at the lower end of the income spectrum. In our state, the 20 highest poverty rates all belonged to rural counties.
With much of the rural population living in poverty, many of the patients that enter rural hospitals are uninsured. And because individuals without health insurance are less likely to go to healthcare practitioners for minor ailments, they often wait until their conditions have become severe. The treatment of these individuals, while moral and just, leaves healthcare providers and the hospital uncompensated. This continued treatment of patients without insurance leads these hospitals into states of bankruptcy, causing them to shut down.
Since 2010, North Carolina has seen a substantial number of potentially avoidable rural hospital closures. We are in a group of six other southern states which have experienced five or more rural hospital closures since 2010 — all of which have forgone any Medicaid expansions.
Expansion of Medicaid has been assessed to greatly improve the state of rural hospitals. The medical journal Health Affairs published a study that found that “Medicaid expansion was associated with improved hospital financial performance and substantially lower likelihoods of closure, especially in rural markets.”
Democrats in the House and Gov. Cooper must hold steadfast in this reasonable expansion of Medicaid eligibility. Since the Affordable Care Act was passed in 2010, permitting states to more easily expand Medicaid via federal funding, 36 states have utilized this feature. North Carolina happens to be one of the 14 states that have not had any expansions in that 8-year period. Republicans, too, are becoming increasingly aware of NC’s need for Medicaid expansion; however, they continue to bring unfit policy proposals to the table.
A 2017 Republican proposal would have expanded Medicaid to those that were employed or actively looking for employment. In addition to the employment clause, this proposal also would have forced the Medicaid beneficiaries to pay a monthly premium for what is supposed to be a free program.
Such a proposal would have failed to incorporate all of the people that are in need of healthcare while also setting an economic burden on those that did qualify for the program. Democrats must ensure that their expansion of Medicaid coincides with the righteous purpose of giving healthcare access to as many Americans in need as possible. Republicans in turn must step up to the table and pass laws that would benefit thousands of their constituents.
For a state that has truly seen the pitfalls of not expanding Medicaid, North Carolina must make Medicaid expansion a non-negotiable issue. Access to proper healthcare should not be reserved for those fortunate enough to afford it. For our state to continue to be a prosperous place for all people, we must see that healthcare is treated not as a privilege, but as a universal right.
