By Rose Hoban

Four years have passed since the North Carolina legislature passed Senate Bill 4, which rejected an opportunity to provide health insurance access to about half a million low income people in the state: Four years, one governor, one president, and countless rallies, petition drives, protests, focus groups and meetings with legislators.

All to no avail.

woman holds a photo of her son, she looks at the camera
Health care advocate Leslie Boyd (right) speaks to Sen. Floyd McKissick (D-Durham) about her son, Mike, who was diagnosed with a late stage cancer 10 years ago, but had difficulty finding treatment because he was uninsured. Mike died soon after. Photo credit: Rose Hoban

Still, advocates came to the legislature on Tuesday to press lawmakers to take advantage of an Affordable Care Act provision that would allow for the state to extend Medicaid coverage to low income North Carolinians who make too much to qualify for the current program, but not enough to qualify for subsidies to cover the costs of their insurance premiums.

“Right now we’re turning away $2 billion per year,” Sen. Floyd McKissick (D-Durham) told a room full of advocates at a press conference Tuesday morning. “That’s $2 billion that’s being contributed to the federal government in Washington and it’s not coming back to our state because we have refused to expand Medicaid.”

McKissick noted that Congress’ failure to repeal the law last month means the ACA remains the “law of the land,” but he said that it might not be the case for long.

“They’ll keep working on it, they’ll keep tinkering with it, they’ll keep doing something with it likely, that at some point may decrease our chance to expand Medicaid,” he said.

Uncovered health care workers

One irony of starting her own business, said Nancy Ruffner, was that even though she helps people navigate the complicated healthcare system, she is unable to afford insurance for herself.

Small change

Currently, 31 states have chosen to expand Medicaid, many of those states are controlled by Republicans who initially opposed the legislation.

But the money was too good for many Republican governors and legislatures to resist. And now some are even fans, such as Ohio Gov. John Kasich, who told NBC’s Meet the Press that Republicans in Congress should not kill Medicaid expansion.

“You have to have the ability to subsidize people at lower income levels,” he said.

A report generated by Ohio’s Department of Medicaid found it saved money even as it improved the health of about 700,000 of beneficiaries.

Under pressure from governors such as Kasich, the Congressional American Health Care Act would have allowed states that had expanded the program to continue covering those extra people.

But the states, such as North Carolina, that didn’t expand Medicaid would receive $10 billion to split among themselves over three years. An analysis by North Carolina Institute of Medicine head Adam Zolotor calculated North Carolina’s share of that money would come to about $172 million per year, while expansion would have brought at least $2.5 billion to the state annually.

“I’ve been in the North Carolina workforce since 1973, I’ve been paying taxes for 44 years” said Ruffner who employs four other people in her medical case management firm, Navigate NC. “I work. I pay taxes. I own small business and I’m helping others to work and pay taxes.”

She said when she worked for someone else, she got insurance through her job. And when she started Navigate NC in 2014, she got a subsidy through the ACA insurance marketplace.

But starting a small business often means being the last person to get paid, and some years the pay is less than in others.

“I’m pouring 100 percent of my income back into the company during its early years and I received no salary,” she said. “This enrollment year I could not honestly vouch that I would make the threshold of income necessary to qualify for a subsidy.

“I would not lie in order to make that income threshold.”

Erica Pettigrew said it’s common to see uninsured patients who are health care workers.

Pettigrew, who serves as the medical director at the Orange County Health Department, told the story of a patient, who worked for 35 years as a medical assistant. Now the woman works as a personal health aide, a job that comes without insurance.

When she came in to see Pettigrew for care at the health department recently, she had a suspicious lump in her throat.

“She really needed to see an ear, nose and throat specialist but she doesn’t have coverage and there was nothing I could do,” Pettigrew said. “This woman had devoted her career to helping others and yet she does not have access to affordable health care and she is not going to be able to get potentially life-saving treatment.”

woman in a white coat stands at a podium talking, another woman looks on
Dr. Erica Pettigrew told people at the General Assembly about how she frequently treats patients who work as caregivers, yet have no insurance of their own. Behind her, Duffner looks on. Photo credit: Rose Hoban

Pettigrew said these situations are frustrating.

“Words cannot express what it feels like as a physician to see a patient possibly dying before your eyes and not able to get the care that she needs simply because she does not have health care coverage,” she said.

Not budging

But when asked whether there was any chance of expanding the program, Sen. Tommy Tucker (R-Waxhaw) was blunt.

“No way,” said Tucker, who is an outspoken member of the Senate Health Committee. “We can’t take on that kind of a bite of an apple like that, because we don’t know what’s gonna happen [at the federal level].”

Tucker was dismissive of other Republican-led states that had made the move.

A man shows a small booklet to a woman.
Lee Storrow from the NC AIDS Action Network shows someone who came to the legislature Tuesday some case studies of working people who would benefit from Medicaid expansion. Photo credit: Rose Hoban

“They only reason they’re doing it is because the Republicans in Washington couldn’t get their health care bill through,” he said. “So they’re going to put a stake in something that we all know potentially is going to blow up… we’re not going there.”

He said that for this year, budget writers have been told to keep the Medicaid budget on a “flat line.”

Despite the resistance in the legislature, Lee Storrow from the North Carolina AIDS Action Network said he’s going to keep organizing days like Tuesday to bring people to the General Assembly to talk to lawmakers.

“As advocates doing work for people who need health care it’s our job to continue to raise awareness about the fact that expanding Medicaid and closing the coverage gap would save hundreds of lives and create thousands of jobs,” he said.

“We’re going to continue to beat the drum the best we can.”

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Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...