‘I Want to See Her Grow Up’: A North Carolina Mom on How Medicaid Expansion Would Change Her Life

The state House approved a bill to expand Medicaid access to 600,000 more North Carolina residents on Thursday.

Dana Bango always had health insurance.

But about seven and a half years ago, Bango lost her coverage when she stopped working full-time and took a part-time job to spend more time with her daughter. Her new job also allowed to work in the nonprofit sector, where she could give back to her community.

Bango, a 55-year-old single mom living in Western North Carolina, always planned on picking up additional work and getting insurance again. Then both of her elderly parents got sick, and she found herself juggling care for both them and her child. 

Becoming a sandwich caregiver made it more difficult for Bango to pick up any extra work, and the cost of health insurance didn’t fit in her paycheck-to-paycheck budget. As a result, she’s lived without health insurance coverage for nearly eight years. 

She “did pretty well” for most of that time, Bango said. “I stayed healthy. I was good. I dodged the bullet.”

But about a year and a half ago, Bango started feeling sick. She went to the local free clinic and was referred to a specialist. Several months later, she finally got her diagnosis: endometrial cancer.

Thankfully, her cancer was in the early stages. She would just need a hysterectomy and to have her gallbladder removed. But Bango lives in Zionville, a rural community in Watauga County just minutes from the Tennessee border, where healthcare access is limited. 

“We don’t have surgical oncologists here,” Bango said.

She was also uninsured, which posed a financial hurdle to treatment. But the team at Novant Health’s outpatient surgical center in Winston-Salem, where Bango would ultimately get treatment, told her they would operate on her. She could worry about the cost later, they said. 

The surgery was a success and Bango was back to her part-time job at the North Carolina Christmas Tree Association just two weeks later. She remains cancer free and still feels healthy today, though the removal of her ovaries triggered menopause, an adjustment she’s still getting used to.

The main issue affecting Bango is now the $30,000 in medical debt she has hanging over her head due to her treatment.

“I told them I can’t pay for it any time soon, cause my daughter’s getting ready to go to college next year and I have credit card debt too,” Bango said. 

Worse, Bango is scared of what might happen in the future if she remains uninsured. 

“What if something else happens? What if [my cancer] recurs? What if I have an accident? I’m already 30 grand in debt and something else can happen again,” she said.

The financial stress and the uncertainty of living without insurance are why Bango is hoping that the North Carolina General Assembly will finally, after nearly a decade of Republican opposition and delays, expand Medicaid health insurance this year as part of the Affordable Care Act’s opt-in expansion program. 

In a promising sign, the North Carolina House voted to approve Medicaid expansion on Thursday.

What Medicaid Expansion Would Mean to North Carolina

Bango would be one of an estimated 600,000 low-income North Carolina residents who would get health insurance coverage under Medicaid expansion. 

Thirty-nine states have expanded Medicaid under the Affordable Care Act, allowing them to offer coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level ($18,755 for an individual in 2022), with the federal government covering 90% of the costs. 

Under the bill introduced by Republican Rep. Donny Lambeth, hospitals would pay for the remaining 10%.

Thanks to President Biden’s 2021 American Rescue Plan, North Carolina would also receive a $1.5 billion payment from the federal government to treat traditional Medicaid patients if the legislature agrees to expand Medicaid.

Medicaid expansion has been shown to save lives and improve postpartum maternal health outcomes. It would also expand access to mental healthcare and substance use treatment amid the state’s growing mental health and addiction crises.

“If we can get more people on Medicaid, they would have access to a much wider array of behavioral health services,” Kelly Crosbie, director of the North Carolina Division of Mental Health Developmental Disabilities and Substance Use Services, told Cardinal & Pine in a recent interview. 

Expanding Medicaid coverage would also create tens of thousands of jobs in the state and be a huge boost for North Carolina’s rural communities, which have seen 11 hospitals close since 2006. A 2018 study using nearly a decade’s worth of data found that hospitals in Medicaid expansion states were 84% less likely to close than facilities in non-expansion states.

Where the Bill Goes From Here

Lambeth’s bill now heads to the state Senate, where top Republicans have their own priorities they want added to the legislation, such as a measure to loosen “certificate of need” laws that require health regulators to approve any hospital’s expansion plans. Senate Republicans also want to allow some specialty nurses the freedom to practice without being supervised by a physician.

“It’s not the bill that we need in North Carolina expanding Medicaid,” Sen. Majority Leader Phil Berger said of Lambeth’s bill last week.

If Senate Republicans introduce their own version of the bill, leaders of the House and Senate would likely negotiate and seek to reach a compromise on one agreed-upon bill to expand Medicaid.

Bango has waited for this moment for years. Despite the looming uncertainty, she’s more hopeful than ever.

“I’ve been sad, I’ve been mad, I’ve been all kinds of things. But at this point, just the fact that we’re so close, I’m ready to throw all those negative feelings away if it actually passes,” she said. “It’s a victory and it’s some progress and I don’t care how we got here. I don’t care how or why they changed their minds.”

If Republicans finally expand Medicaid, it would be life-changing for Bango. 

“It would relieve my stress. It would relieve that thing that’s always behind me, that sense of financial insecurity,” she said. “And then of course that chronic stress is going to give you chronic health issues.” 

Most importantly, health insurance would improve Bango’s odds of staying healthier longer and seeing her daughter grow up. 

“My daughter’s getting ready to graduate high school. I want to see her live a little bit. I don’t think it’s time for me to go yet,” Bango said. “I want to see her grow up. I want to be part of her life as much as possible…The main thing that I want now is to be here for her and to be here for her, I have to be healthy and I have to be alive.”