Two years after the start of the Affordable Care Act and three years after the N.C. General Assembly and Gov. Pat McCrory blocked federally funded expansion of Medicaid to cover the working poor, it’s time to remind our legislators of the effects of their decision: the avoidable costs, the unnecessary deaths, the intolerable cruelty.
On Saturday, I am rising early with other health care workers and students to carpool and bus to Raleigh, where we’ll march once again down Jones Street for some old fashioned rabble-rousing.
Since the ACA started, 31 states and DC have expanded Medicaid. Ten states led by conservative Republicans, initially vehemently opposed to Medicaid expansion, have reversed course. In three states where Republicans subsequently won governorship, they elected to continue the expansion. Two Republican-led states are in discussion to expand.
These leaders came to their senses when they realized the benefits in savings, the jobs created, the federal dollars flowing to their states instead of away, and the help to their citizens. When that many Republican governors and legislatures have expanded Medicaid, it is difficult to understand why McCrory, Senate Pro Tem Phil Berger and Speaker of the House Tim Moore have ignored the economic and health benefits to the state.
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Before 2008, health care costs were spiraling out of control. In the 30 years before then, the inflation-adjusted per capita increase in total health care costs rose by more than 3 percent annually for most of those years, reaching greater than 4 percent in half of the years, straining our nation’s budget and that of its businesses.
From 2008 to 2014, national health care costs increased less than 3 percent annually and less than 2 percent for four years despite the 16.9 million citizens newly insured. Mid-size and large companies also benefited with the average health care cost increase of only 3.2 percent in 2015, the lowest rate increase since 1996. This might explain why the Chambers of Commerce quietly lobbied for Medicaid expansion in many of those Republican-led states.
Some individual states are also seeing savings. Through June, Medicaid expansion had saved Kentucky nearly $110 million and Arkansas nearly $120 million in health care costs.
One of the major provisions of the ACA is the expansion of Medicaid eligibility to nearly all low-income individuals with incomes at or below 138 percent of poverty ($27,724 for a family of three in 2015). Eight percent of the uninsured nationally live in N.C., where 244,000 earn less than 100 percent of the federal poverty level. An additional 186,000, whose income falls between 100 and 138 percent of the federal poverty level, would be eligible if we expanded. Among these 430,000, 66 percent live in a family with at least one person working or where they themselves are working.
Who are these working poor? They are your neighbors: 59,000 construction workers, 56,000 food service workers, 46,000 sales workers such as Walmart cashiers, 43,000 cleaning and maintenance workers, 36,000 textile and laundry workers, 34,000 bus and taxi drivers and 32,000 administrative support staff. Amazingly, 16,000 are in the health care industry! They pay their share of taxes, build our houses and companies, feed us, sew our clothes, serve our burgers and greet us, answer our phones and take care of our elderly parents and yet they have nothing to help them avoid developing life-threatening chronic diseases.
With two years of data available, the health benefits of expanding Medicaid are clear. In states that did not expand Medicaid, rural hospitals have been closing as they could no longer afford to provide free care. From 2010 to 2015, 57 rural hospitals closed, 42 of them – including three in North Carolina – in states that did not expand Medicaid. Rich or poor, it is nice to have a hospital close when your heart stops beating.
Medicaid expansion also allows for more preventive medicine. The governor and legislature have adopted the concept of penny wise, pound foolish. From blood pressure control to cholesterol and diabetes care, the cost of treatment for complications far exceeds that of prevention.
In April the legislature reconvenes. They should listen to the health care workers across the state and lift the block on Medicaid expansion.
Charles van der Horst, M.D., is a retired professor of medicine at the University of North Carolina in Chapel Hill.
10th Annual Moral March
What: HKonJ People’s Assembly
When: Saturday – gather at 8:30 a.m., march at 10 a.m.
Where: Gather across the street from Raleigh Memorial Auditorium at 2 East South St.
More information: nando.com/hkonjmarch