This week, four North Carolina House members held a press conference announcing Carolina Cares (HB662), a proposal to help close the health-care coverage gap in North Carolina. The plan would expand access to health-care coverage to an estimated 200,000 working North Carolinians who do not earn enough to afford insurance premiums, but also do not qualify for Medicaid. Rep. Donny Lambeth (R-Forsyth) referred to the bill as a “win-win” solution that expands coverage while being revenue neutral. Fellow sponsors Rep. Josh Dobson (R-McDowell), Rep. Gregory Murphy (R-Pitt), and Rep. Donna White (R-Johnston) all spoke from their perspectives as rural legislators about the potential impact of this legislation on people living in our state’s rural communities.
At the Rural Center, we agree that accessible, affordable health care is important to the future of our state. The coverage gap traps thousands of our neighbors: small business owners, farmers, fishers, beauticians and firefighters. These are hardworking people who want to pay for and manage their own health care but just do not earn enough to cover their families.
Carolina Cares would have an immediate impact on the health and well-being of the working poor. But for rural areas, expanding health coverage is also a jobs issue. It helps people who have jobs. It helps people keep jobs. It helps people create jobs.
The Rural Center’s most recent Rural Assembly—our annual gathering of rural leaders from around the state—was focused on the intersection of health care and economic development, and the takeaway was clear: A strong health sector is itself a rural economic catalyst, helping retain small businesses and attract the new industries and jobs that are so desperately needed.
That’s because without healthy workers, rural businesses pay additional costs. Without financially stable health-care systems, rural communities cannot keep the businesses they have, and will be unable to attract new ones.
Healthy communities are essential for vibrant, competitive rural economies and continued private sector business investment. However, 70 of the 80 rural counties in North Carolina are currently designated “medical deserts” for their lack of primary care availability. And seven rural hospitals in North Carolina are at risk of closing, which would cost the state an estimated 2,360 health-care jobs and $2.7 billion in GDP.
How might Carolina Cares contribute to a vibrant rural health sector? It would help shift the health-care business model from a fee-for-services, critical care model to a prevention-based, accountable care model that has more effective health outcomes and is economically more efficient. It puts individuals in charge of managing their own health plans, and promotes primary care visits over costly emergency room visits. According to early estimates, this might result in a $45 million annual cost savings to the State of North Carolina.
Even beyond this direct cost savings to the state coffers, the economic impact to rural North Carolina would be real. Estimates from The George Washington University suggest that bridging the coverage gap would result in a $5.6 billion economic boost to rural counties in North Carolina over a four-year period. This would support more rural practitioners and help the financial position of at-risk rural hospitals. Closing the coverage gap could bring up to 43,000 jobs to the state of North Carolina.
There is still work to be done on the bill. There are still details to be sorted out. The sponsors of Carolina Cares recognize that and understand that more discussions are needed. But the Rural Center commends the sponsors for tackling the coverage gap head on. There are more than 500,000 people in our state without insurance, and that is too many. It is important to make sure that hardworking people are not crippled by debt just because they get sick.
Closing the coverage gap may be difficult, but it is not impossible for our state’s leaders to work together on important issues. We saw it just this week when the Strengthen Opioid Misuse Prevention (STOP) Act passed the House unanimously.
We congratulate Speaker Tim Moore and the members of the House of Representatives on both sides of the aisle for passing common-sense legislation to curb the opioid epidemic plaguing our cities and towns. Now, in that spirit of bipartisanship, we encourage the members of the House and Senate to thoughtfully explore how to make Carolina Cares work for North Carolina. This proposal charts a course toward providing access to needed care for the working poor while grounding that expanded access in fiscal and personal responsibility. Now comes the hard part – working together to pass a bill that may not be any one individual’s preferred solution, but in the sum makes sense for the people of North Carolina.
The Rural Center stands ready to work with leaders to do just that, and we encourage citizens to communicate to their representatives the value of closing the coverage gap in North Carolina. Because if there is another issue we can agree on unanimously, it is that a strong health-care sector is vital for the well-being of both our people and the North Carolina economy.
Patrick Woodie is president of the NC Rural Center.