Growing momentum of Affordable Care Act shines spotlight on NC’s failure to expand Medicaid

With the Affordable Care Act’s enrollment deadline now upon us; there are two overarching conclusions to be drawn about the health care reform law and its impact here in North Carolina.

Conclusion Number One is that the law has been a remarkable success. Notwithstanding its initial website problems and all of the roadblocks erected by North Carolina politicians, enrollment numbers have exceeded expectations. Two-hundred thousand North Carolinians had already secured health insurance by March 1 – a number that exceeded the March 31 goal of 191,000. The number could approach 300,000 by the time all the dust has settled. These numbers are a testament to the hard work of a lot of ACA “navigators” as well as the state’s huge unmet need.

Conclusion Number Two is that Gov. McCrory and the General Assembly continue to make a huge mistake – both for the wellbeing of their constituents and the state’s economy – with their obstinate refusal to expand eligibility to Medicaid for a half-million low income individuals who desperately need it.

Both of these truths about the health law were on full display recently as I and the rest of the North Carolina Justice Center’s health group hosted a public meeting in the Beaufort County town of Washington.

The success of the new law was made plain during a presentation at the gathering by local Affordable Care Act counselor Claudia Stokes. Working long hours out of the local community health center, Stokes and her staff have helped enroll hundreds and hundreds of residents in affordable coverage in one of the more rural areas of our state.

(It’s worth reiterating at this point the fact that North Carolina actually had $74 million in federal grants sitting in the bank and a plan to hire 500 people to travel the state helping our citizens get affordable care. Unfortunately, Governor McCrory and General Assembly leaders, in addition to blocking Medicaid expansion, voted to send all that money back to the federal government and not hire anyone to help our citizens.)

The success of Stokes and her team in overcoming the obstructionism of state leaders is typical of many smaller communities and helps explain the state’s overall enrollment success. Washington is far from the larger metropolitan areas of our state, but while the absolute numbers of people without insurance are obviously lower than in Raleigh or Charlotte, the percentage of people without coverage is much higher. This fact – which is typical in more rural areas — has kept those on the front line of the Affordable Care Act (people like Stokes) extraordinarily busy. Fortunately, however, they have risen to the occasion.

The second critical truth to come out of our Washington meeting mirrored what we have found all over North Carolina: the Governor’s and General Assembly’s decision to block Medicaid expansion in is creating immense hardship. This harsh reality came into sharp focus as we listened to story after story of people utterly devastated when they realized that they were “too poor” to get help from the Affordable Care Act because of North Carolina’s decision to maintain a “coverage gap.”

And, of course, the impacts of this decision go well-beyond simply denying insurance to deserving individuals. Especially in our rural counties, the refusal to expand Medicaid places enormous pressure on health providers. Beaufort County’s rural Belhaven hospital (which is on the brink of closing because the failure to expand Medicaid and the impact of that decision on hospital revenues) is a classic example.

Still, despite North Carolina’s many shortsighted policies and the self-inflicted wounds made so apparent by the testimony of those in attendance at the Washington, there remains much cause for hope and optimism. First, it’s clear the Affordable Care Act is making a significant difference in the lives of people in every corner of North Carolina. Second, as the momentum of the Affordable Care Act continues to build, it will be increasingly difficult for opponents to resist the expansion of Medicaid – especially as more and more people come to understand (as many conservative governors have) that the federal government will cover 100% of the cost for three years and 90% thereafter.

Put simply, despite many practical and political challenges, health care reform is here to stay as the law of the land. North Carolinians would be well-served if their elected leaders acknowledged this reality and started doing their best to implement the law rather than undermine it.

Adam Searing is the Director of the North Carolina Justice Center’s Health Access Coalition.