Three years after lawmakers rejected the possibility, Medicaid expansion continues to be a heated topic.
By Minali Nigam
With officials from the state Department of Health and Human Services wrapping up work on an overhaul of the state’s Medicaid program this week, lawmakers, physicians and patient advocates gathered at the General Assembly Wednesday to push for Medicaid expansion to be included in the state’s reform plan.
Dozens gathered for a press conference in the state legislative building that featured patients who could qualify for the state’s Medicaid program but don’t.
“For a long time, policymakers were reluctant to talk about closing the health care coverage gap until they had passed through the Medicaid reform package,” said Michelle Hughes, executive director of NC Child. “We feel it is a great opportunity to turn their eyes to expanding Medicaid.”
North Carolina remains one of 19 states that have thus far declined to expand Medicaid, which was allowed for under the Affordable Care Act. The federal bill, known more commonly as Obamacare, made it possible for states to add people to Medicaid rolls who make less than 133 percent of the federal poverty level, about $32,300 a year for a family of four.
Not expanding the program leaves out almost 500,000 individuals who can’t afford health insurance on their own, and could benefit from health care services, said Sen. Floyd McKissick (D-Durham).
Childless adults almost never qualify for Medicaid in North Carolina, which provides health coverage for low-income children, some of their parents, pregnant women, low-income seniors and people with disabilities.
Sonya Taylor is one patient in the coverage gap.
“I fight tooth and nail and just scrape and scratch for every little bit of medical attention I get. It’s very disheartening,” she said.
In 2011, Taylor was diagnosed with a degenerative disc disease and needed a six-hour back surgery. That was when she had Medicaid. Then in 2012, when she was in aftercare and about to receive physical therapy, her Medicaid terminated because she was no longer eligible. She didn’t have the money to pay for her providers and had to stop treatment.
“How can you start that process and then refuse to see me?” she asked. “I was so shocked as to what I was going to do.”
She’s able to go to her $25 primary care visits through donations from her church community and by doing side jobs like mowing lawns and cleaning houses. Both of Taylor’s parents died from cancer, and she said she is starting to present some suspicious symptoms, but has no way of paying for screening and diagnostic tests.
“I’ve got grandchildren. I want to watch them grow up,” she said.
Family physician Stephen Luking has been in practice for 30 years and became emotional when describing how many of his uninsured patients can’t get the preventative care they need to avoid sickness and death.
“Poor income and family health status are often beyond their control,” Luking said. “Who are we to pass judgment?”
He gave multiple examples of patients who would have benefited from Medicaid expansion: the parents of a disabled son, a young woman with rheumatoid arthritis, a man who quit his good job to care for his mother.
“I watched as our current political leaders decided to put partisan politics ahead of common humanity when they denied expansion,” he said. “This was a life-and-death calculation that was made with callous disregard to the needs of the poor.”
Since Obamacare went into effect in 2013, nearly 20 million more Americans are insured, according to an early 2016 U.S. Department of Health and Human Services report. Charlie van der Horst, an HIV doctor at UNC-Chapel Hill, said the states that have approved expansion save on costs and see fewer deaths.
“Several studies have shown that the premature-death rate decreases in states who have expansion,” van der Horst said. “In North Carolina, this means there are 1,000 to 2,000 unnecessary deaths each year.”
He described a patient who had hypertension, lost health insurance and could no longer pay for medications. He said the patient runs the risk of renal failure, which van der Horst said would require dialysis costing about $75,000 per year – money that would come directly from taxpayers.
McKissick said forcing people into reactive treatment rather than prevention causes a bigger financial burden.
“There’s no compelling reason,” McKissick said, for not expanding Medicaid. “A study showed even if we expand Medicaid to the point where North Carolina was paying 10 percent of cost, it would still pay for itself in this state.”
He also said expansion would create as many as 43,000 jobs in North Carolina related to health care.
Waiver without expansion
The deadline for submitting the state’s Medicaid reform paperwork to the federal Centers for Medicare and Medicaid Services is next Wednesday.
“I’m hoping that as CMS reviews our application for the waiver to move from a fee-for-service to a capitated payment, that part of that will be a discussion about expanding Medicaid at the same time,” said Rep. Verla Insko (D-Chapel Hill).
“Several other states have done that, and it actually facilitates their expansion because it brings in a lot of new money.”
North Carolina Medicaid head David Richard said otherwise.
“The legislation did not allow for any expansion in the waiver, and so there won’t be one,” he said.
CMS hasn’t set a deadline for when the state will be notified about the waiver. Richard said that because this is a presidential election year, the approval process will be slower than usual.
“There’s no question that CMS will want to discuss expansion, but I think the waiver is strong on its own merits,” he said. “I think it’s consistent with the goals that CMS has, and I think they have a good chance of getting it through.”
McKissick told advocates to make sure the issue stays at the forefront.
“We cannot put the health care needs of 500,000 people on the backburner,” he said. “Be relentless, because it will not change today. But what we can do is provide a pathway to reconsider where we are.”
Correction: A photo caption in this story originally stated that Sonya Taylor is from Fayetteville.