Faith and Health Summit 2022 Mindful Together
  • Skip to primary navigation
  • Skip to main content
  • Skip to footer

NC Council of Churches

Strength in Unity, Peace through Justice

  • Voices
  • About
    • Overview
    • Staff
    • Members
    • Covenant Partners
    • Issue Statements
    • Governing Board
    • Careers
  • Programs
    • NC Interfaith Power & Light
      • NCIPL Overview
      • Faith in Action NCIPL
      • NCIPL Articles
      • NCIPL Resources
      • Upcoming Events for NCIPL
      • Contact NCIPL
    • Partners in Health & Wholeness
      • PHW Staff
      • Mini-Grants
      • PHW Collaborative Pledge
      • Faith and Health Summit 2022 Mindful Together
      • The Overdose Crisis: The Faith Community Responds
      • Mental Health Advocacy
      • BIPOC Mental Health Grant
      • Growing Communities of Inclusion: A Faithful Response to HIV
      • Healthy Aging
      • Citizen Science
      • PHW Articles
      • FAQs
  • Priorities
    • Racial Justice
    • The Overdose Crisis: The Faith Community Responds
    • Gun Violence Prevention
    • Criminal Justice
    • Immigrant Rights
    • Public Education
    • Farmworkers
    • Legislative Advocacy
    • Christian Unity
    • Peace
  • Events
  • Resources
    • COVID-19 Resources
    • Publications & Reports
    • Raleigh Report
    • Lectionary
    • Sermons
  • Donate
  • Council Store
  • Show Search

Search NC Council of Churches

Hide Search

Expand Medicaid? Now’s the time

Steve Ford, Former Volunteer Program Associate · November 16, 2014 · 1 Comment

Click here to sign up to receive the Raleigh Report in your inbox

The decision last year by the conservatives who control North Carolina’s state government not to expand the state’s Medicaid program has left an estimated half-million residents out in the cold when it comes to health insurance – that’s the number cited by the N.C. Institute of Medicine.

These folks typically are among the state’s working poor, with incomes that might rise above the poverty line but not by much. As a practical matter, the lack of health insurance means they simply do without the kind of routine medical care that insured people take for granted. Small problems all too readily can become big ones that send sufferers to a hospital emergency room.

The hospital might try to collect payment, saddling a family with what could be a whopping debt. Or the hospital’s costs of “charity” care are passed along to other, insured patients in the form of higher charges. Either way, it’s not a rational way to deliver health care, or to pay for it.

Health care and social justice advocates, including the Council of Churches and affiliates such as the NC Conference of the United Methodist Church and the NC Synod of the Evangelical Lutheran Church in America, have spent months making the case for Medicaid expansion. Now, with legislators looking forward to a new session in January and Gov. Pat McCrory beginning to anticipate a 2016 re-election campaign, there’s some reason for optimism that the Medicaid picture could change.

What drives that optimism is the power of plain economics – North Carolina stands to receive an economic jolt from additional Medicaid spending, with most of the money coming from Washington. The logic is increasingly hard to deny. But concern for those half-million neighbors of ours who finally would be able to see a doctor when they need to – without enduring an expensive emergency room visit – should be part of the equation as well.

Long way down

Medicaid now serves the disabled and the poor, especially families with young children. But low income alone doesn’t qualify a childless adult for coverage. Under the Affordable Care Act engineered by President Obama, states were supposed to expand their Medicaid programs so that people without children would be among those eligible, so long as they earned no more than 138 percent of the federal poverty level. (That translates to an income of $15,415 for a single person.)

The idea was that expansion would bridge the gap between traditional Medicaid and the ACA., which is supposed to make health insurance coverage affordable to lower-income people by subsidizing their payments. No expansion, no bridge. Welcome to the gap!

That’s what happened in a number of states when the US Supreme Court invalidated the expansion requirement. Those states – all led by Republicans who were opposed to the Affordable Care Act in general – decided that when it came to expansion, they’d rather pass.

Their reasons were both practical and political. They didn’t want to add to the federal deficit. They worried that even though federal taxpayers would be paying for most expansion costs, their states might eventually have to contribute large sums. And they didn’t want to help Obama further his agenda.

For their purposes, presidential failure was a happy outcome indeed. And the idea that some Americans, fortunate enough to have financial means, might be asked to pay more in taxes to help give others among us reasonable access to the health care system evidently was beyond the pale.

On second thought …

But common sense has a way of influencing the conversation. With large amounts of federal Medicaid money ready to be tapped by states that expanded their programs, some states with conservative leadership, such as Indiana and Utah, began negotiating on the details. North Carolina, too, could try to work out an arrangement that conservative legislators and their fellow Republican in the governor’s office could live with.

A deal would mean an estimated $14.8 billion in new federal spending here over the next eight years. The money would flow into thousands of health care jobs, helping keep budget-strained hospitals afloat and strengthening local economies. A study commissioned by the NC Department of Health and Human Services projects that even though the state would have to pay a portion of the expansion costs after the first three years, it would save money over an eight-year period due to increased tax collections and other advantages.

And all the while, thousands of North Carolina residents who – cruel irony – don’t make enough to qualify for subsidized health insurance under the Affordable Care Act would be able to get care when they needed it, including the kind of routine care that keeps people out of hospitals and even saves lives.

As it happens, the future of Medicaid in this state, whether expanded or not, is the focus of heated debate. Legislators have bridled at what they see as poor management and runaway expenses, although the state’s per-capita costs are on the low side. Gov. McCrory has pressed for various reforms in how the program operates. If he were to convene a special legislative session in the coming weeks to consider those reforms, as he has indicated he might, it’s possible that expansion might be in the mix. It should be.

Costs in perspective

Another telling point in favor of expansion is that as things stand, North Carolina’s federal taxpayers are helping finance broader Medicaid benefits in other states while their own state receives zilch. Yes, it has to be stipulated that Medicaid is costly – reflecting inefficiencies in our largely fee-for-service health care system as much as anything – and that a larger program spread across more states would come with a larger bill. It’s perhaps understandable that some conservatives, eyeing those costs, would conclude that this hole doesn’t need to be dug any deeper.

Still, there are huge costs, both financial and societal, when thousands of residents cannot afford to receive basic health care – when to be treated even for a perfectly manageable illness or condition can force them to incur a mountainous debt, or essentially to pass the buck to other patients.

People in that predicament may end up losing their jobs when they become too sick to work. Families can be crushed by the weight of poverty compounded by illness. Every rung of North Carolina’s socioeconomic ladder – and especially those rungs that now are among the shakiest – would be strengthened if a path toward the expansion of Medicaid can be found.

Filed Under: Blog, Homepage Featured, Raleigh Report Tagged With: Children & Youth, Health, Healthcare Reform, Mental Health, N.C. General Assembly

About Steve Ford, Former Volunteer Program Associate

Much goes on in North Carolina's state capital that's important to the Council of Churches. I'm glad to have a chance to help follow the action, transitioning from my career with The News & Observer of Raleigh, where I retired in 2012 as editorial page editor. I'm originally from Virginia but have lived in Cary so long I remember the Kildaire Farm barn.

Read more of my commentary here.

Reader Interactions

More Like This

Because of Jesus
The Perfect Gift for Mother’s Day
PHW Faith and Health Summit: Thank You

Comments

  1. Herman Kleine says

    July 22, 2016 at 1:29 am

    Steve, while I believe every American should be able to receive the medical care they need, including preventive care, I also believe that we are a long way from finding the right solution. As a volunteer counselor at Dorcas I see the people you are talking about. It is not unusual for a mother to have children on Medicaid with not insurance for herself. It is also common for clients not to carry even subsidized insurance under the ACA plan because they cannot afford the premium and believe they are better off to pay the penalty for not carrying it.
    Some insurance companies are leaving the ACA and we in North Carolina are close to being left with a insurance company as an ACA provider thus being equivalent to a single payer government plan. In the past health insurance was just that. It was carried to underwrite the unforseeable health care needs much like fire insurance. Over time we have added coverage for everyday health care needs and preventive medicine which has transformed the system and turned it into somethng like a healthcare savings plan which has increased the costs dramatically. At the same time the folks I see continue to use the emergency room as a family doctor when absolutely needed and otherwise not using health services due to the cost. I do not have a solution but don’t think a simple expansion of national medicare is the right one. We need to try many different solutions on a more localize level. Long ago my wife worked as a public health care nurse operated by the city. This was the medical resource used by the poor and it seemed to work well. Something along the lines of today’s urgent care facilities. In addition there was a large teaching hospital operated by the city that also functioned as the city charity hospital. Most of the patients were those who could not pay. All of this was funded by the city taxpayers.

    Reply

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

Footer

Contact

NC Council of Churches
27 Horne St.
Raleigh, NC 27607
(919) 828-6501
info@ncchurches.org

Facebook

Partners in Health and Wholeness

Featured

Expand Medicaid? Now’s the time

Latest Tweets

RT @NCCADP We have so much planned to mark the anniversary of NC's last execution. Read all about it on our blog and make a plan to join us as we say: Never again! #deathpenalty bit.ly/3C0lZkf

About 2 days ago

With the growing threat of the climate crisis, NC is looking toward new ways to get to zero carbon emissions. Last week, @NCIPL staff members Susannah Tuttle & Ren Martin attended a public hearing in Charlotte. wfae.org/energy-envi…

About 3 days ago

RT @MomsRising Moms of color don't have adequate break time or private space to pump. Urge lawmakers to support breastfeeding & working mothers! moms.ly/3Qi3gnN _ Las mamás de color no tienen un tiempo de descanso adecuado o un espacio privado para bombear. #NBM22 #IPumpedHere #PUMPAct pic.twitter.com/V3Yw…

About 4 days ago

Welcome our newest staff member, Ren Martin, NCIPL & Eco-Justice Connection Program Coordinator! Ren aims to uplift and empower people to create a more sustainable future for us all. We are excited Ren has joined our team! pic.twitter.com/3VLZ…

About a week ago

This month we are excited to announce our @healthandfaith Interim Co-Directors: Jessica Stokes & Nicole Johnson. Jessica & Nicole have dedicated their hard work to supporting faith communities across NC. They will continue to do this work while overseeing the PHW program. pic.twitter.com/SU8Q…

About 2 weeks ago

Follow @ncchurches

Latest Tweets

Do you know what grant is right for your faith community? Check out the graphic below to learn about the differences between grants. Click here to learn more informationhttps://www.ncchurches.org/programs/phw/phw-mini-grants/ pic.twitter.com/umXb…

About 6 days ago

RT @FaithCompassWFU If we look at the HIV epidemic as an opportunity to bring healing, justice, and equity to those who have been marginalized and impacted by the health industry and society at large, we can generate more good in our communities. #breakthestigma #faithcompassWFU pic.twitter.com/FPIB…

About 2 weeks ago

RT @ncchurches This month we are excited to announce our @healthandfaith Interim Co-Directors: Jessica Stokes & Nicole Johnson. Jessica & Nicole have dedicated their hard work to supporting faith communities across NC. They will continue to do this work while overseeing the PHW program. pic.twitter.com/SU8Q…

About 2 weeks ago

RT @ncchurches This July, during BIPOC Mental Health Month, we invite faith communities of color to think about programs, initiatives, and ideas that will lift up BIPOC Mental Health and use the grant money @healthandfaith will offer to make that idea come to light! ncchurches.org/bipoc… pic.twitter.com/DMwT…

About 2 weeks ago

Supporting our friends at @rafiusa @CTTTNC program WNC Gathering today! pic.twitter.com/iuRL…

Last month

Follow @healthandfaith

Latest Tweets

Press Conference happening now #CLT #NCCarbonPlan #FossilFreeNC pic.twitter.com/Rizq…

About a week ago

RT @ClimateNexus Faith-based organizations, including @CreationJustice and @NCIPL, are hosting an evening of discussions and workshops on building climate resilience on August 18 from 5 pm to 8 pm ET. Register here: bit.ly/resiliencesum… pic.twitter.com/fuz8…

About 2 weeks ago

RT @averydavislamb Preachers and pastors! This weekend when you pray for and preach on the heat waves, wildfires, and other disasters, try mentioning that these are intensified by climate change. Here's what I've been praying...

About 3 weeks ago

RT @cress_cd A thread summarizing Carbon Plan comments filed by intervenors. This thread is to relay info without editorialization. I'm NOT taking a position--good, bad, or indifferent--re: arguments raised by other intervenors.

About 3 weeks ago

RT @mocleanair A new study found hundreds of toxins in natural gas from residential sites, including toluene and benzene in 94-95% of samples. Read more, call ALL your elected leaders for just clean energy: ow.ly/ICTi50JKSug @GCVoters @scennetwork1 @uscan @enviRN @docsforclimate @CEHN

About a month ago

Follow @ncipl

Latest Tweets

Copyright © 2022 NC Council of Churches · All Rights Reserved · Website by Tomatillo Design · Hosted by WP Engine