20 Percent of NC Adults Lack Health Insurance. Are Lawmakers Helping?

The coronavirus has exacerbated NC’s healthcare crisis, but the major roadblocks to Medicaid expansion in the state Senate remain.

As North Carolina Sen. Terry Van Duyn watched states like Missouri and Oklahoma pass Medicaid expansion this summer, Van Duyn, an Asheville resident, couldn’t help but think about her hospital close to home.

Two years ago, Asheville’s Mission Hospital, run for more than a century by a well-respected nonprofit, announced plans for a long-expected sale to the for-profit HCA Healthcare.

Since then, she says the hospital’s nixed rural oncology services, and it’s been shredded by local physicians and residents for purported staff shortages and eroding patient care. 

“The stories out of Mission are frightening,” says Van Duyn, a Democrat who sits on the state Senate’s pivotal Health Care Committee.  “And in fact, my doctor told me that he won’t let me go to Mission if I were to need emergency care.”

“We had a nationally ranked hospital and we will never have that again,” Van Duyn added.

None of this was necessary, she says. The budget shortfalls that initiated Mission’s change of ownership could have been filled, at least in part, by an expansion of Medicaid services that North Carolina’s state legislature has blocked for the better part of a decade.

These concerns are not new.

Since the Affordable Care Act was passed and signed into law in 2010, Republican legislators in North Carolina have blocked a component allowing states to opt into a federally-funded expansion of health insurance for low-income people.

The expansion could improve healthcare access for hundreds of thousands in the state, and the federal government would pick up 90% of the tab.

GOP legislators in NC opposed expansion even in the first three years of the ACA program when it was paid for entirely by the federal government.

Critics of Republican leadership point out that lawmakers passed up billions of dollars in healthcare funding in the last decade. And they say that expansion could be a lifeline for struggling hospitals like Mission Hospital. However, expansion opponents have argued that they believe the program could eventually undermine state budgets, a prediction that has not yet materialized in states that opted into expansion. 

And the economic carnage wreaked by the novel coronavirus, which has killed 2,570 and infected more than 157,000 North Carolinians, has only bolstered the case, some say.

A new report released in July by the nonpartisan health care advocacy organization Families USA should be convincing to legislators who are reluctant to embrace expansion. The report concluded a record number of Americans, including 240,000 North Carolinians—20% of NC adults—are without healthcare insurance now, many because they lost their jobs this spring as the pandemic hit American shores.    

That report also found NC, like other Southern states, to be among the hardest hit in the US when it comes to its number of uninsured people during the pandemic.

Lawmakers have indicated there is bipartisan support for some form of expansion in the state House of Representatives, but as recently as May, the top legislator in the Senate, Sen. Phil Berger, remained opposed, NC Policy Watch reported, leaving NC today as one of 12 states in the US still blocking Medicaid expansion. 

This month, NC Health News reported that the state’s top health care official, Secretary of Health and Human Services Mandy Cohen, urged lawmakers to act on expansion, a top priority for the legislature’s longtime foil, Gov. Roy Cooper.

“My point is, is that why aren’t we using every tool that’s out there to maximize how much federal support is coming to our state, particularly when Medicaid expansion doesn’t require any state dollars,” Cohen reportedly told legislators. “We should be reaching for all that federal support at this moment in time to respond to this crisis, particularly a health crisis.”

Still, the Senate Health Care Committee, chaired by Davie and Forsyth County Republican Joyce Krawiec, has been quiet on the issue.

Van Duyn and state Sen. Natalie Murdock, both Democratic members of that committee, said the panel has had no substantive conversations about expansion.

“The issues are even greater than before because a lot of the people who’ve gotten sick with COVID are blue collar folk who make too much money for Medicaid and don’t have enough for private insurance,” state Sen. Gladys Robinson, a Greensboro Democrat, told Cardinal & Pine in June. “Those are the folks in the coverage gap, and they need the insurance to get healthy and stay healthy.”

Neither Krawiec nor Berger responded to interview requests for this story, and when contacted by Cardinal & Pine in June, Krawiec’s office referred to us as “fake news.”

But top Democrats in the legislature say GOP opposition is hurting the state and its people.

“There are hard positions in health care and I know that,” Van Duyn said in a recent interview with Cardinal & Pine. “But you want to do it from a position of strength, and leaving billions of dollars on the table is not a position of strength.”

Van Duyn said that in Berger’s recent comments about expansion, the influential legislator suggested people who already have health care would have their care imperiled because there might not be enough doctors to go around. 

“He’s totally willing to ration access to health care as long as he’s able to access it,” she said.

Murdock said now is the “perfect time” to expand Medicaid, given the state’s surging number of uninsured people.

“For whatever reason, we lack the political will in North Carolina to do that,” she said.

“Democrats have filed these bills,” said Murdock, referring to legislation filed to expand Medicaid. “They don’t see the light of day. At this point, to not provide that critical health care to a lot of North Carolinians struggling, it’s just heartless and cruel.”