Democrats in the NC legislature decry racial health disparities in their renewed push for Medicaid expansion

Democrats in the legislature renewed their press for Medicaid expansion, saying a Tuesday news conference that getting more people insured will reduce racial health disparities and help the economy.

Sen. Mike Woodard, a Durham Democrat, said there are signs that Republicans in the legislature who have long opposed Medicaid expansion are willing to talk about it.

“I think there are glimmers of hope,” he said.  “I think there are frameworks for us to move forward.”

North Carolina is one of a dozen states that has not adopted Medicaid expansion as allowed under the Affordable Care Act.  Last session, Senate Republicans said they did not like an expansion-like proposal called Carolina Cares that House Republicans crafted. The Carolina Cares bill never got out of the House.

Expansion is a top priority for Gov. Roy Cooper, and he once again has included it in his budget proposal.

Estimates for how many more people in the state would be insured with expansion start at 500,000. Many are childless adults younger than 65.

The most recent federal relief package includes financial incentives for more states to expand Medicaid. North Carolina would see a net gain of $1.2 billion, according to a Kaiser Family Foundation estimate.

Senate leader Phil Berger, an Eden Republican, told the Associated Press that the extra federal money is time limited and that coverage gaps could be addressed without “creating a whole new level of entitlement in the state of North Carolina.”

Senate Republicans this year have shown interest in allowing adults who use Medicaid to keep it under limited circumstances.

Three Republican senators, including Sen. Joyce Krawiec, one expansion’s fiercest opponents, are the main sponsors of a bill filed Monday that would allow women who use the government insurance program while they’re pregnant to keep the coverage for a year after giving birth rather than have it cut off after 60 days.

House Democrats, including Rep. Verla Insko of Chapel Hill, filed a similar bill last month.

The American Rescue Plan allows states to expand what’s called pregnancy Medicaid to 12 months postpartum.

Doctors, policy experts and others say that 60-day cut off doesn’t give some mothers time to have their postpartum medical visits or seek treatment for postpartum depression.

The American College of Obstetricians and Gynecologists has made extending postpartum Medicaid coverage a priority, saying it will help reduce the rate of maternal deaths. Medicaid pays for more than half the births in North Carolina.

At their press conference, Democrats highlighted  the racial disparities in maternal and infant deaths to make their case for Medicaid expansion.

The latest state data, from 2019, shows that Black and Native American babies in North Carolina are more than 2.5 times more likely to die before their first birthdays than white infants.

“The longer we wait to expand Medicaid, the more babies we will see die unnecessarily, particularly Native American and African American babies,” said Rep. Charles Graham, a Democrat from Robeson County who is Lumbee.  “This is not acceptable.”

At 6.8 deaths per 1,000 births, North Carolina has the 12^th highest infant mortality rate in the nation, according the Centers for Disease Control and Prevention.

The CDC reports  wide racial disparities in maternal mortality.

Black and Hispanic adults are more likely to fall into what’s called the coverage gap, where they make too much to qualify for Medicaid and too little to qualify for subsidized premiums in the health insurance marketplace, according a 2020 report from The Commonwealth Fund.

The same report said that states that expanded Medicaid had helped reduced the racial disparities in health care coverage so that Black residents in  states that expanded Medicaid were more likely to have health insurance coverage than white residents of  non-expansion states.

The uninsured rate in North Carolina varies wildly by race and ethnicity, said Sen. Natalie Murdock, a Durham Democrat. Nine percent of Asian -American residents are in the coverage gap she said, while 12% of Black residents and 31% of the Latinx population are in the gap.

At the press conference Insko said military veterans are among those who would benefit from Medicaid expansion.

“We should look at the broad picture of what we’re doing and who we’re hurting by not expanding Medicaid,” she said. “We’re hurting the uninsured, we’re hurting their families, we’re hurting the state because it increases the cost for everyone.”

Expanding Medicaid ensures that essential workers can live free of medical debt and fear, said Rick Glazier, executive director of the NC Justice Center. (NC Policy Watch is a Justice Center project.)

”Medicaid expansion is one of the best policy interventions the General Assembly can take to reduce health care disparities, and make sure communities of color can get the care they need particularly during a time when communities of color have borne the brunt of the COVID epidemic,” he said.