North Carolina is taking significant strides towards improving health care access through Medicaid expansion. The state’s recent initiative extends Medicaid coverage to adults aged 19 to 64 with incomes up to 138% of the federal poverty line. This expanded coverage includes visits to doctors, annual check-ups, emergency care, as well as dental and mental health services.
Medicaid Expansion Benefits
William Bleser, the research director for health care transformation at the Duke-Margolis Institute for Health Policy, emphasizes the advantages of expanding Medicaid, especially in a state with many uninsured and underinsured residents. Bleser notes that this expansion can provide crucial services “essentially at zero cost to those who truly need them.”
As of August 5, the latest update from the North Carolina Medicaid Expansion Dashboard reveals that 520,667 out of an estimated 600,000 eligible residents have secured health insurance through Medicaid. This number reflects an increase of nearly 21,000 from July. The full impact of the Medicaid expansion is still unfolding.
The North Carolina Department of Health and Human Services reported that 273,000 residents enrolled on the program’s first day, with a significant portion coming from the family planning population who transitioned to full coverage automatically. Given that the program is relatively new, it is anticipated that at least a year of data collection will be necessary to fully understand its initial effects.
Bleser highlights the significance of this expansion in the context of the U.S. being the most expensive country for health care per capita. “Imagine a low-income individual managing to cover their basic needs and then gaining access to essentially fully covered health care—that’s a remarkable change,” he said.
Current Enrollment Statistics
According to the Medicaid Expansion Dashboard, as of August 5, the largest age group enrolled is between 19 and 29 years old, representing 35% of the total. Urban residents account for 62.4% of the enrollments, while 37.6% reside in rural areas.
Challenges in Expanding Health Care Access
Rebecca Whitaker, a research director at the Duke-Margolis Institute, notes that Medicaid coverage is crucial for accessing necessary health services, particularly for chronic conditions. High enrollment rates in rural areas suggest that outreach efforts are having a positive effect. However, Whitaker also points out that residents in these areas may still encounter barriers, such as insufficient health care infrastructure.
A shortage of primary care providers further complicates access. This shortage is partly due to historic underfunding and burnout from the COVID-19 pandemic. The American Medical Association estimates that 83 million people nationwide lack adequate access to primary care due to a shortage of doctors.
Moreover, some individuals who previously lacked coverage and had to forego necessary care may harbor distrust towards the health care system. Bleser acknowledges this challenge, stating, “Individuals who feel abandoned by the system may be skeptical and hesitant to engage with health services.”
Evaluating Medicaid’s Impact on Health Disparities
Barak Richman, a distinguished professor of law and executive core faculty member at the Margolis Institute, believes that the North Carolina Department of Health and Human Services (NCDHHS) is making commendable progress in enrolling residents. However, he cautions that Medicaid alone may not fully address health care disparities.
Richman refers to an experiment in Oregon where expanding Medicaid access increased utilization but did not significantly impact physical health outcomes. He also points out that Medicaid’s ability to provide financial assurance is often undermined by aggressive hospital billing practices that lead to medical debt.
In response to this issue, Governor Roy Cooper’s administration recently received federal approval for a plan aimed at reducing medical debt. The initiative aims to encourage hospitals to eliminate up to $4 billion in medical debt for 2 million low- and middle-income North Carolinians.