I’m a Small-Town NC Doctor. My Patients Shouldn’t Have to Choose Between Rent and Medicine.

Senate President Pro Tempore Phil Berger, R-Rockingham, in January 2021. Berger's office has long opposed Medicaid expansion in North Carolina. (AP Photo/Gerry Broome)

By Laura Ucik

May 28, 2021

A family care physician from Henderson on how North Carolina lawmakers’ refusal to expand Medicaid has impacted the families she sees.

As a primary care doctor, I try to keep politics out of my medical decisions. I focus on the person in front of me and what they need. 

But working in North Carolina, every clinical choice centers on one question: Do you have health insurance?

When I suspect a life-threatening blood clot, I must ask: Do you have the $2,000 to pay for an ultrasound at our local hospital? Is this test more important than rent?

The disparity in access to resources and care carries the gravest of consequences. Not a day goes by without a patient telling me about the unexpected loss of a loved one. 

A favorite sister in her 50s died from a heart attack last week. A 38-year-old son died from kidney failure just yesterday. The recent killing of Andrew Brown Jr. is yet another reminder: Untimely death is the real pandemic here, ravaging our towns long before the deadly coronavirus. 

I am stemming a flood, patching holes where we could be building alternatives. We have funded policing in an effort to keep our citizens safe. But as Durham Mayor Pro Tempore Jillian Johnson said in 2019, “The safest communities don’t have the most cops; they have the most resources.” 

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And indeed, the deck is stacked. During my recertification in CPR, our training video asserted that heart disease does not discriminate. But the data says otherwise. We know that the stress of simply existing in America as a person of color, as a person without access to wealth, or as a person carrying a legacy of trauma, increases one’s likelihood of having a chronic medical condition. Black Americans are at approximately double the risk of having a first stroke as their white counterparts. 

An Indigenous person born in our state can expect to live 5.1 years less than if they were born in California. 

And in NC, nearly 1 in 3 Latinx individuals could not see a doctor in the past 12 months due to cost alone. Doctors have racial bias. Hospitals provide differential treatment. And here in North Carolina, health insurance compounds that, often determining my patients’ fate.

But this year, there is a window like never before. Just as Durham Beyond Policing, Raleigh PACT, and other organizations have introduced dozens of bills to help reshape our systems of policing, we have a rare opportunity with the federal grants built into the American Rescue Act.

This is neither socialism nor charity. It will not increase our healthcare costs or suddenly overburden our healthcare system. Already, we are exhausted by the challenges of providing quality care to people without insurance, relying on small federal programs and sending bills that never get paid. But now, we have the opportunity to extend coverage to more than 682,000 North Carolinians. 

Accepting this federal incentive to expand Medicaid will save money, today and for decades to come. My patients can stop agonizing over impossible decisions, scrambling to save up the cash for the stress test that could save their lives. Almost 70% of NC voters now favor expansion; why doesn’t the NCGA agree? 

Let’s invest in prevention, and stop turning manageable diagnoses into a lifetime sentence of unpayable hospital bills. Let’s invest in real safety. North Carolina, I implore you: I am trying to keep politics out of my healthcare decisions, but right now, the services I provide are determined by politics and politicians. This is our opportunity to make a change, and for my patients, time is running out. 


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