Point of view

Time for NC Republicans to accept ACA success, expand Medicaid

March 28, 2014 

Before the Affordable Care Act was signed in March 2010, 2.7 million North Carolinians were uninsured. Businesses went bankrupt due to health insurance costs. Americans were trapped in jobs, anchored by health insurance coverage, which stifled innovation. The quality of our health care suffered compared with other countries and yet the cost of care was rising fast enough to bankrupt Medicare, Medicaid and the U.S. budget. Our hospitals were filled with patients, ill for want of affordable, comprehensive preventive care.

Luckily, the Affordable Care Act is now the law of the land, and over 6 million Americans – including 200,000 North Carolinians – have purchased insurance, 25 percent of them young and healthy. Those who have signed up for insurance on healthcare.gov realize that life is fickle. You can be healthy today and struck with multiple sclerosis tomorrow. Which is better – to have the security of health insurance at an affordable price or to rely on the vagaries of fate?

Thanks to the Affordable Care Act, adults and children with pre-existing conditions like diabetes and autism can once again purchase insurance. The donut hole or gap in medication coverage for our Medicare seniors is gone. Life-time caps on healthcare expenses have vanished. And treatment of mental illness now has parity with medical illness. For the first time in decades, health care spending has decreased as a percentage of the Gross Domestic Product.

To help pay for the insurance, families with four members and an annual income of $94,200 receive subsidies, and single people earning up to $45,960 do as well.

What’s more, the Affordable Care Act is unleashing pent-up entrepreneurial energy. Previously, employees of large companies were tied to those companies if they or their family members had pre-existing conditions. Now, if someone working for SAS or GSK has a bright idea for a new company, the next Apple or Google, he can safely leave knowing that health insurance is affordable and portable. Yet Republicans keep trying to create some fake bogeyman: Ooooo, beware having health insurance with free preventive care. It’s so awful that President Obama is helping you get mammograms, PAP smears, cholesterol and blood pressure screening. It’s nutty thinking on the part of paranoid partisans.


Those North Carolinians whose incomes exceed 100 percent of the federal poverty level should register for insurance by March 31 to avoid penalties of up to 1 percent of income and to benefit their health and that of their families.

As most know, North Carolina and 24 other states have rejected the Medicaid expansion that would provide health insurance coverage for 300,000 to 500,000 working North Carolinians whose incomes are below the poverty level. North Carolina is not a healthy state as we suffer from high infant mortality, low birth weight and diabetes. We rank in the bottom 20 states for premature deaths primarily due to cancer and cardiovascular deaths.

The North Carolinians whom state Rep. Thom Tillis, state Sen. Phil Berger, Gov. Pat McCrory, and Budget Director Art Pope are preventing from getting federally funded insurance have the worst health in the state, cost hospitals the most money for unnecessary emergency room visits and hospital admissions, and receive uncompensated care, leading to an increase in insurance premiums for all of us with private insurance. This is a financially nutty decision.

Rejecting an expansion of Medicaid for thousands of hard-working, tax-paying North Carolina families relegates thousands to needless deaths for the simple lack of appropriate preventive care. Here in North Carolina, that translates to an estimated 1,000 to 2,000 annually or three people every day. Financially nutty and morally wrong.

Expanding Medicaid in North Carolina would not only give workers access to preventive care but also would bring almost $15 billion in federal funds into our state and create 25,000 jobs. The federal government will fund the entire cost of the expansion for the first three years, and that percentage never falls below 90 percent at least until 2020.

Every year that North Carolina delays implementing the Medicaid expansion the state surrenders billions of our tax dollars that will go to other states to bolster their economies. This includes states led by conservative Republican governors including Arizona, Florida, Ohio, Michigan and Nevada. Financially nutty.

Rather than playing cheap politics and staging show hearings, Tillis, Berger, McCrory and Pope should improve the lot of all North Carolinians and seek to increase access to health care by expanding Medicaid immediately.

Charles M. van der Horst, M.D., is a professor at the UNC School of Medicine in Chapel Hill.

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