Daycare employee Remontia Greene tends to three infants in a preschool in Clayton, NC, in 2009.  (Photo by Ted Richardson/Raleigh News & Observer/Tribune News Service via Getty Images) North Carolina Childcare
Daycare employee Remontia Greene tends to three infants in a preschool in Clayton, NC, in 2009. (Photo by Ted Richardson/Raleigh News & Observer/Tribune News Service via Getty Images)

The owner of a North Carolina childcare center remembers Ms. Kathy and Ms. Brenda, two employees who fell into the state’s Medicaid coverage gap.

As our country begins to move past the COVID crisis, I’d like to tell the story of a different healthcare crisis — one that continues to claim the lives of many Americans.

Here in North Carolina, health care is kept just out of reach from working class folks who fall into the Medicaid coverage gap. It’s a troubling story that I know too well after losing two of my employees to the coverage gap. 

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I own and operate two childcare facilities that serve primarily low-income and working-class families. Our children come from a variety of backgrounds –they’re children of essential workers, children in the foster system, and many come to me with child care vouchers.

Even before the pandemic, the childcare industry was reaching a crisis point. Childcare facilities operate with razor-thin profit margins. Employees must be college graduates, yet the industry’s median pay is $13 an hour lacking many benefits, namely health insurance. As a result, childcare workers leave the industry for better paying jobs.

Many small business owners that cannot afford to provide benefits depend on government programs to retain them. But North Carolina has failed to expand Medicaid for nearly a decade, and childcare employees — mine included — fall into the Medicaid coverage gap. They don’t earn enough to afford health care and they earn slightly too much to qualify for Medicaid. 

Every business needs healthy employees, but as an understaffed childcare business in the midst of a pandemic, the health of my employees is critical. I wouldn’t fully understand this connection until I lost two employees to the coverage gap.

I told my husband, if another employee loses their lives from being uninsured, I can’t do this anymore. I refuse to run a business where employees can’t take care of themselves.

Ms. Kathy was one of my first employees when I started my business in 2012. She worked early morning hours to open the facility for the children’s arrival. Ms. Kathy excelled at teaching, but she was also a hard-working mother of three who struggled with health problems.

With no affordable healthcare coverage, Ms. Kathy couldn’t seek treatment from a doctor and passed suddenly of a heart attack. We were devastated, but three years later, the unthinkable happened again.

Ms. Brenda worked in childcare all of her life, and, as a mother of three, she loved being around children. She suffered from high blood pressure, but couldn’t afford to see a doctor or afford medication. She tried treating herself with home remedies. Ultimately, a heart attack sent her to the hospital. On the day doctors scheduled Ms. Brenda’s open heart surgery, she suffered a deadly stroke. 

It took losing two teachers to realize their deaths resulted from being uninsured. I’ve tried to provide my staff with health coverage, yet Medicaid expansion is the most feasible solution.

Unfortunately, North Carolina’s state legislature has repeatedly blocked Medicaid expansion

To break this obstruction, the Biden administration has proposed a federal solution. In non-expanded states, the plan would offer ACA marketplace plans at zero cost to individuals who fall into the Medicaid coverage gap. If Congress approves this federal approach, my employees can access health care. 

I told my husband, if another employee loses their lives from being uninsured, I can’t do this anymore. I refuse to run a business where employees can’t take care of themselves.

I want to put a face to policy decisions that keep people from accessing health coverage. Kathy and Brenda were hard-working Americans who cared for the most vulnerable children, but they couldn’t afford to take care of themselves. Until something is done, we will risk losing more people because they couldn’t afford to see a doctor.

I urge our leaders to support workers and small businesses like mine by closing the Medicaid coverage gap.