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Medicaid expansion would improve NC rural residents’ health and local economies, experts say

This story originally published at N.C. Policy Watch

Patrick Woodie, president of the NC Rural Center, offered a robust endorsement of Medicaid expansion at a legislative committee meeting Tuesday, saying that more insured residents would lead to better physical health and improved community financial health.

Rural North Carolinians are disproportionately uninsured compared to residents of the state’s suburban and urban counties, he said, with rural counties representing 20 of 22 counties in the state where more than 20 percent of adults younger than 65 don’t have health insurance.

Medicaid expansion “is important for the state and rural communities in particular,” Woodie said.

The Joint Legislative Committee on Access to Healthcare and Medicaid Expansion heard its second day of presentations Tuesday on the government health insurance plan and challenges to building a healthcare workforce.

Expansion is important for rural counties, Woodie said, because it would support local economies and small businesses, and help rural hospitals.

For more than a decade, most Republicans in the state legislature have rejected expanding Medicaid. North Carolina is one of 12 states that has not expanded the health insurance program. The committee’s creation was included in the latest state budget. Committee co-chairman Donny Lambeth, a Winston-Salem Republican, said last month that he hopes to have a package of recommendations for the legislature to consider before the end of this year.

Most childless adults do not qualify for Medicaid. Parents who qualify have incomes far below the federal poverty level.

Sixty-five percent of adults without health insurance are employed, Woodie said.

Low-income adults are said to fall into a coverage gap, because they make too much to qualify for Medicaid, but too little to buy health subsidized insurance from a marketplace set up under the Affordable Care Act.

Some adults work for employers who do not offer health insurance, or at jobs with insurance plans that have premiums that are unaffordable for low-wage workers.

About 600,000 adults would be expected to enroll if the state expands Medicaid, according to Urban Institute estimates.

The federal government pays nearly 74 percent of the state’s Medicaid costs. For adults added under Medicaid expansion, the federal government would pay 90 percent. In the past, some House Republicans have suggested coming up with the remaining 10 percent by assessing hospitals.

The federal government offered states that have not yet expanded a financial inducement, which for North Carolina would mean $1.6 billion to $1.7 billion over two years.

North Carolina had the 6th highest uninsured rate in 2019, according to the American Community Survey, and 11.5 percent of the state’s adults avoided getting medical care because of the cost.

North Carolina was 35th in the Commonwealth Fund ranking of overall health system performance, said Hemi Tewarson, executive director at the National Academy for State Health Policy.

Studies show a Medicaid expansion increases access to healthcare for rural residents, helps rural hospitals’ bottom line, reduces hospital closures, and reduces uncompensated care, she said.


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