A Policy Statement of the North Carolina Council of Churches, January 1997
Four years ago, the Council of Churches issued a policy statement on health care that expressed concern about the large number of North Carolinians without adequate health insurance and about the high and increasing cost of health care. Our concern is especially great for those most vulnerable in our society: the poor, children, people of color, and the elderly. At that time, we called for a national health plan that would guarantee universal coverage for health care, coupled with effective cost control, broad-based and equitable financing, and assured quality of services.
In the four intervening years, it seems that nothing has changed and yet everything is different. Reform efforts have resulted in relatively minor changes in the availability and delivery of health care. Changes implemented by the health care and insurance industries, especially the introduction and rapid growth of managed care, affect millions of people. Proposed and adopted changes in the structure and funding of federal, state, and local programs providing health care for people in or near poverty threaten to increase the numbers with inadequate access to health care.
The Current Status
- In 1995, some 1.2 million North Carolinians (17.4% of the total population) were uninsured at one time or another. This includes 627,000 who were without health insurance of any sort (including Medicaid) for the entire year. An additional 1.1 million were considered to be underinsured.
- Thirty percent of the uninsured are poor, 28% are near poor (100% to 200% of federal poverty level), and 42% are middle class.
- Nationally, health care spending continues to grow at a rate about double that of inflation.
- The number of health maintenance organizations (HMOs) in North Carolina has increased by 120% over a two-year period. About 10% of the state’s population is enrolled in full-service HMOs.
We continue to call for the establishment of universal health care coverage as the only way to ensure access to basic health care for everyone. Until this long-term goal is reached, we support the following interim measures:
- Strengthen the regulation of managed care in order to provide greater protection for consumers. These protections should include, but not be limited to, setting minimum access standards, guaranteeing coverage of emergency room services when the patient had a reasonable belief that emergency care was needed, including coverage of mental health services, prohibiting discrimination against providers serving special populations with higher than average health care needs, and including enrollees/patients on managed care governing boards.
- Increase the use of Medicaid, especially by increasing eligibility, improving outreach efforts to those who qualify, and making services easier to access.
- Expand the use of school-based health centers, especially in counties with high numbers of uninsured school-age children.
- Assure access to health care, especially for emergency services and deliveries, for immigrants.