The Moment I Realized Medicaid Reform Was a "Big Deal"

I have to be completely honest, health insurance was not something I really thought too much about until I got older. Like, “you are finally an adult with bills so you need to think about this now” older. As a child, it was not something I actively thought about. One, I was a kid so health insurance was definitely not high on my priority list and two, I was not a “sick kid,” so I only really went to the doctor’s office when I had to get vaccinated or get a physical to play sports at school (which was also rare). It was not until I reached the magic age of 26 that I was faced with the harsh reality that health insurance is necessary. And very expensive.

Like most young adults, my first job did not immediately shower upon me loads of money. I made enough money for bills, essentials, and literally nothing else, including health insurance. When I tried to get coverage under the Affordable Care Act (ACA), the only plans that I qualified for were completely out of my budget. When I tried to apply for Medicaid, I was told that I made too much money to qualify but if I had a child, things would be different, which was puzzling to me. Did the the fact that I had a child or not change my very real reality of not being able to afford health insurance? Before I had too much time to seriously weigh those options, I got offered a new job...WITH BENEFITS. To say I was excited would be an understatement. Now, I did not have to load up on vitamins to prevent myself from getting sick or entertain the idea of having a child in order to get health coverage. I assumed that everyone who was struggling to get health coverage was like me and when they found the right job or opportunity, they too, would be covered as well. I was very wrong.

On March 31, 2016, the North Carolina Department of Health and Human Services (NCDHHS) held a public hearing in Huntersville, NC, in order to get public input about the privatization of Medicaid in North Carolina. The Kaiser Family Foundation estimates that in North Carolina, 244,000 people do not have any option for affordable coverage; however, it is estimated that nearly 500,000 people would be eligible for coverage if the state expanded Medicaid and closed the coverage gap. Everyone from health providers to legislators to community organizers were all in attendance. Also in attendance were Medicaid beneficiaries, the people whose care will ultimately be affected by these proposed changes. After a brief introductory presentation about the proposed Medicaid reforms, the hearing was opened for public comments.

As expected, we heard from a number of doctors and legislators, whose main concerns appeared to be financial. Most doctors present were in support of Medicaid expansion because they saw first hand the negative implications of not closing the gap in their hospitals. They reported about patients who would come to the emergency room instead of a general practitioner for treatment because they could not afford the doctor’s visit. Since emergency rooms do not turn away patients, hospitals are forced to eat up these additional costs. Expanding Medicaid coverage reduces uncompensated care that hospitals and other healthcare providers currently absorb, which would lead to a stronger health system that is better able to take on innovative approaches to reduce costs and improve care.

Legislators who spoke during the public hearing discussed the financial ramifications of closing the Medicaid gap and the financial impact that it would have on the state’s budget. The Cone Health Foundation released a report analyzing the economic impact of expanding Medicaid in 2016 and found that closing the gap in North Carolina would result in net savings for the state budget, despite any new costs of the program. The report also estimated that if North Carolina expanded coverage in 2016, the state would see $318 million in net state savings from 2016 to 2020.  

As the public hearing went on, the conversation started to take on a more personal tone. More and more participants shared their personal experiences of being in the Medicaid coverage gap. We heard from a man without children who previously lived in another state where he had coverage, but was later placed in the coverage gap after he moved to North Carolina and later sustained serious injuries that required medical treatment that he could not afford. Another woman shared the story of her son’s current unique placement in the coverage gap. A few years ago, this woman’s son suffered a severe brain injury that required extensive long-term medical treatment, which was covered under Medicaid. However, a slight change in injury classification requirements resulted in her son not qualifying for Medicaid, placing him in the coverage gap. Why should someone with a severe brain injury not get the treatment he needs because he does not have the “right kind of brain injury?”

Towards the end of the public hearing, an older man talked about how he was recently diagnosed with diabetes. He stated that if it were not for Medicaid, he would literally be dead because he would not be able to afford all of the medications that he would need to stay healthy. It was not until this man spoke that I really felt the gravity of this debate. I knew that not expanding Medicaid would prevent lower-income people from getting coverage, but what I did not realize was that not expanding Medicaid would literally result in death for the most vulnerable people, especially those living with chronic illnesses. In North Carolina, 1,100 people have died as a result of being in the Medicaid coverage gap. Expanding Medicaid is so much more than just a “great idea;” for many, it could be the difference between life and death. Let that sink in for a minute. Expanding Medicaid will literally save lives. When you think of it in that context, it immediately becomes a black and white issue. We have to not only expand Medicaid in North Carolina, but we must also be sure to represent the needs of everyone affected to ensure that no more lives are lost unnecessarily. The need to expand Medicaid coverage in North Carolina can no longer be seen as just an option that policy-makers are entertaining; it needs to be a priority. We cannot sit and watch the people of our state die around us while we have the opportunity to stop it.