Lawmakers falter on Medicaid expansion in the coronavirus relief package

With more than one million North Carolinians who have lost their jobs in a system where many workers receive health insurance through their employers and over 49 rural hospitals losing millions per month, the need for Medicaid expansion is paramount. 

Yet, state lawmakers moved forward in passing the coronavirus relief package with very limited and temporary extension of the state’s Medicaid. The House’s provision allowed for temporary expansion of Medicaid for COVID-19 testing and treatment to people but was blocked by the Senate.

The final bill only allows temporary Medicaid coverage for a COVID-19 patient’s treatment of coronavirus-related illnesses.

From News & Observer:  

As a result (of blocking Medicaid expansion), almost 500,000 low-income citizens lost proffered heath care coverage, though the federal government would have paid almost the entirety of the bill. The decision cost the state billions of health care dollars, tens of thousands of jobs, an array of rural hospitals, and thousands of lives.

Little explanation was given, beyond statements that “expansion wasn’t good for North Carolina.” But the decision made two things clear: our Republican lawmakers hated President Obama and they were launching what would soon become a successful campaign to out Mississippi Mississippi. These two inaugural, defining steps began, instantly, to diminish the well-being and life chances of hundreds of thousands of Tar Heels. With the advent of the new coronavirus, they now expand exponentially the tragic hardship faced by massive numbers of our sisters and brothers.

To put the Medicaid rejection in context, Dr. Steve Luking, a family practice physician from Reidsville told me:

“I’ve watched my patients with no insurance pay a terrible price. I’ve seen women die of invasive breast and cervical cancer when they couldn’t afford mammograms and preventative checkups. I’ve spoken to the next of kin in funeral homes about symptoms ignored by those afraid of the cost of evaluation. I’ve seen the slow death by invasive colon cancer in the patient who couldn’t afford a colonoscopy, the diabetic who couldn’t pay for insulin and the resulting dialysis. Despite what people say, the emergency room doesn’t provide the care these folks need. When was the last time someone got a pap smear or a screening colonoscopy in an emergency room?”

The sorts of wounds Luking described – now including delaying treatment for coronavirus infections — have continued over the last seven years as we’ve sent our tax dollars to other states and seen those that accepted expansion (both Democratic and Republican led) notably reduce their rates of uninsured. Our lawmakers effectively pushed their Tar Heel constituents to the back of the national pack. Better to allow thousands to die than to depart from rigid ideological command.

Currently, Medicaid serves over 2.14 million North Carolinians — about 21 percent of the state population. Without Medicaid expansion, between 450,000 and 650,000 North Carolinians will not have adequate health care coverage. 

Despite rural hospitals losing more than $145 million per month, the package allocates only $95 million to help rural and teaching hospitals.

Continued blockage of the health care coverage that would give much needed care for chronic conditions, prevent illness and disease progression, will continue to leave hundreds of thousands at risk. 

Yet, to lawmakers, a temporary fix to their flawed system seems more adequate than providing a permanent health care coverage option for all North Carolinians.

When the second legislature convenes later this month, lawmakers need to consider the safety and health of all North Carolinians. There should never be a limit placed upon the health of any individual.

Alanna Joyner