Five years ago, Congress passed the Affordable Care Act, including Medicaid expansion that became effective in January 2014. Our legislature and governor’s willful rejection of expansion has cost North Carolina up to $6 billion in income and 50,000 new jobs and caused 4,000 to 5,000 North Carolinians to die unnecessarily and many more to become ill, stay ill or be diagnosed with later, more advanced diseases. Further delays will cost another $21 billion, 43,000 jobs and 10,000 lives by 2020.
Now, like hot air balloon salesmen approaching the Wright brothers at Kitty Hawk, come the General Assembly and governor with a move to privatize Medicaid, passed and signed amid claims it will provide more consistent care and put some controls in the system, predictions that will prove untrue.
Accepting expansion would add coverage for an additional 500,000 residents, thus creating jobs in health care, construction, retail and beyond as wages are spent. HB372 will do none of these.
My calculations, derived from Harvard and George Washington University analyses, are not exact science, but they concur with other studies that together clearly indicate expansion saves lives and invigorates economies.
These benefits occur in 31 states including D.C. that have accepted expansion. Kentucky reports from 2014, “Medicaid expansion is expected to … generate a net positive fiscal impact that is $919.1 million higher than had the state decided not to expand Medicaid. Without Medicaid expansion, the Commonwealth would still face many of the same budgetary challenges that non-expansion states face.”
When uninsured indigent patients receive care they cannot afford, we all pay because these real expenses must be redistributed among insured and paying patients. Some smaller hospitals, especially in poorer communities without enough paying and insured patients, are forced to close. Unreimbursed care and hospital closings have declined in expansion states.
Belhaven has median incomes about a third of the N.C. average. Pungo Hospital, the area’s largest employer contributing at least $14 million to the area’s annual economy, closed on July 1, 2014, largely due to non-expansion.
Subsequently, 48-year-old Portia Gibbs died waiting for transport elsewhere. Conservative Republican Mayor Adam O’Neal stated, “She spent the last hour of her life in a parking lot at a high school waiting for a helicopter,” and “the governor and the legislature (by rejecting Medicaid expansion), they’re allowing people to die to prove a point. That is wrong, and I’m not going to be a party to that.” He organized a protest march to Washington, D.C.
Death and suffering continue. The journal Pediatrics recently reported reduced children’s death rates with increased access to Medicaid programs.
North Carolina women with gynecologic cancer who have Medicaid have it discovered at more curable stages than women without insurance. More of the uninsured women will suffer; more will die. Their treatment expenses may be greater and more likely to go unreimbursed.
I love North Carolina, my home the past 39 years, 29 as an ob/gyn physician. I write neither from political power or bureaucratic authority, nor as Democrat, Republican, progressive or conservative, but as an informed citizen disturbed and pained by unnecessary suffering among my neighbors.
Rejection of Medicaid expansion does not reflect North Carolina values. None of us would abet unneeded suffering. We help our neighbors during tough times. No one would hesitate to cloak a shivering family with a nearby blanket simply because we are unhappy with its maker. Over half of new Medicaid recipients would be workers who cannot now afford insurance.
I also can’t believe this represents the values of our politicians, but I fear the fog of hyper-partisan politics obscures their view. True leaders must navigate through these obstacles. Debate tax rates and the roles of private vs. public institutions, but do not fiddle while our brethren suffer and die.
The collateral damage is unacceptable when conflicts of ideologies, parties and personalities leach from Jones Street power chambers into bedrooms of sick children or around kitchen tables where worried people must decide between food and rent money or seeing the doctor.
The excuses have expired, including two Supreme Court decisions. With or without privatization, continued rejection of Medicaid expansion perpetuates a scourge upon compassion and morality. Perhaps we should erect a memorial to those who die and suffer as a result. What would we name it and to what cause shall we say they are sacrificed?
Kenneth J. Fortier, M.D., lives in Chapel Hill.