Census data a powerful reminder of the need to expand Medicaid

By Chris Fitzsimon | Sep 20, 2016

The latest data from the U.S. Census Bureau included some frustrating information about North Carolina and it wasn’t just the state’s sluggish below the national average growth in household median income that the think tanks on the right have mistakenly trumpeted as good news.

The data also showed that the percentage of people without health coverage in the state dropped by 1.9 percent from 2014 to 2015. That means 173,000 people are no longer uninsured thanks to the improving national economy and the Affordable Care Act.

But North Carolina’s uninsured rate is still more than two percent above the national average—and it’s not hard to figure out why. That is the frustrating part.

North Carolina remains one of 19 states that have not expanded Medicaid under the ACA and the gap in uninsured rates between expansion states and non-expansion states keeps widening.

The Center on Budget and Policy Priorities points out that the Census Bureau data showed that states that have expanded Medicaid have an average of 7.2 percent of their population without health care coverage while the average uninsured rate is 12.3 percent in states that have refused expansion.

North Carolina’s rate is currently 11.1 percent with several hundred thousand low-income adults left without coverage because Gov. Pat McCrory and legislative leaders have refused to consider Medicaid expansion.

The news comes as state officials in Louisiana recently announced that more than 300,000 people have signed up for Medicaid coverage since Governor John Bel Edwards expanded the program.

And Republican states have expanded Medicaid too.  Last month New Jersey Governor Chris Christie made headlines for vigorously defending his decision to support expansion and cited the 500,000 people in his state that now have health coverage as a result.

Christie said the success of Medicaid expansion has proven naysayers and critics wrong.

Unfortunately, the critics and naysayers in North Carolina include the folks in power, many whom refuse to consider expansion because they dislike President Obama more than they care about providing access to health care for the people they represent.

And it’s not just about helping hundreds of thousands of people, though you would think that would be enough.

Expanding Medicaid in North Carolina would create thousands of health care jobs and bring in more than $11 billion in federal funding for hospitals in the state, many of which are currently struggling to survive—especially hospitals in rural areas.

And as Gov. McCrory and legislative leaders surely know, the federal government will pick up 90 percent of the cost of expansion which means—as a study by the Urban Institute found—that when you take everything into account the state would actually save more than $300 million over the next five years with expansion.

McCrory has flirted with the idea in the past. At one point his HHS Secretary was reportedly working on an expansion plan.  Then last year McCrory said he was waiting for the U.S. Supreme Court to rule on the constitutionality of health care subsidies in the ACA before he would make a recommendation to the General Assembly.

The court upheld the subsidies and 500,000 people in North Carolina are still waiting on McCrory’s expansion plan that has yet to appear.

Meanwhile, low-income adults in Louisiana, New Jersey, Ohio and 28 other states across the country can see a doctor when they are sick instead of being forced to wait until they have a medical emergency.

That’s what the latest numbers from the U.S. Census Bureau show, that the stubborn ideology and craven political considerations of the folks currently in charge in Raleigh are costing the state’s economy billions of dollars and thousands of jobs and most importantly denying 500,000 access to quality health care.

Let’s hope when the Census Bureau issues next year’s data sets that North Carolina leaders have finally come to their senses.

Comments (7)
Posted by: Ron Rookstool | Sep 21, 2016 09:14

How can the NC GOP look the other way and deny expanding Medicaid? The proof is in the pudding.

Oh well they have also made some really dumb decisions such as HB2, Voter ID, etc.  It is "time for a change", as the Donald says.

Posted by: Allen Alsbrooks | Sep 22, 2016 00:40

Indeed...and  lest we forget they also lowered the income tax for hard working North Carolinians.

Posted by: Charles Zimmerman | Sep 22, 2016 08:34

The tax change was a ruse. It shifted the burden to consumption from income and inheritance alleviating the top brackets from their responsibility as well as violating the obligation of equal protection. AND! While claiming a "flat tax", they actually cut the rate for the top brackets in half compared to the rest of US. "trickle-down" on speed.

King George would be proud of these folks.

Posted by: Allen Alsbrooks | Sep 23, 2016 10:42

And why should we not be taxed on consumption? The more one spends the more tax they pay. I see that as entirely fair. It's much like the taxes levied on cigarettes, alcohol and gasoline/diesel. Only those consuming those commodities pay the tax. Can't get much better than that.

Posted by: Ron Rookstool | Sep 23, 2016 11:23

No problem with a sales tax that is reasonable (not to include labor).  But the wealth always want to get off the hook and not pay their fair share. I believe that was why our forefathers believed in a graduated tax rate. The GOP falsely has advocated that the "Trickle Down Effect" will work. Pray tell me what proof there is that it will work.  Yes it works to reduce the tax burden on the wealthy and to increase their wealth. Personally I believe the flat tax would be better than a consumption tax, provided loop holes were eliminated and that the first $25,000 (as an example)  be tax free for everybody each year.

Posted by: John C Sanderson | Sep 23, 2016 14:27

The simple fact is that government provides services that we all need, and those services must be paid for. Roads, schools, police protection...none of those come for free, and everyone uses them and benefits from having top quality services available. A corollary is that funds to pay for those and other government services come from taxes. So, which taxes will it be? Income taxes, that are going to be greater for those with greater incomes, or sales taxes on every necessity of life, that hit everyone with exactly the same "bill," regardless of the income of the consumer?


It is important, as well, to make a distinction between "luxury" items (e.g., cigarettes, alcohol, gas guzzling vehicles) and "necessary" items (e.g., groceries, fuel - whether for heat or holding a job, clothing). Luxury items SHOULD be taxed at a significantly greater rate than other consumer goods, but there is a difference between a pint of ale and a pint of milk.


Another simple fact is that the mouth of a child living in poverty requires just as much milk as the mouth of a millionaire's child. In fact, children living in poverty probably need more milk and protein in their diets to compensate for possible pre-natal nutritional deficits. So, when a government begins to rely more heavily upon sales or "consumption" taxes there is absolutely no doubt that the burden of paying for those governmental services, that supposedly serve everyone, shifts to those with less disposable income. And there is nothing fair - or efficient - about that.


A "fair" tax hits everyone equally hard - and that's not to say that everyone pays the exact same amount. But a "fair" tax is somehow structured on the basis of one's ability to pay. Basing taxation on everyone accepting a "fair share" of the taxation burden is not "socialism," nor is it economically depressing. We don't have to look that far back in history to see that economic growth in the US was much greater when income tax rates on the wealthy were significantly higher than they are today. "Trickle-down" is truly "voodoo economics." It has never worked, and it never will.


No one likes to pay taxes. I know I don't. But everyone loves having "the best" - schools, teachers, roads, emergency services, whatever. As I've come to understand fully over the years, you truly do get what you pay for. If we want the best, we need to be willing to pay for the best, and those of us with the greatest ability to pay need to be willing to pay our "fair share," and that fair share is going to be greater than the fair share of a single mom working full time at Burger King, trying to provide for herself and a couple of children. Heaping the taxation burden on those least able to pay will result in more stress and struggle for those folks, and it will make it literally impossible for any of us to have "the best" of anything.


As Justice Oliver Wendell Holmes, Jr. famously said, "Taxes are the price we pay for civilized society." While lots of people want to think of taxes in a purely monetary sense, justifying their use of loopholes and low tax payments as being "within the rules," I honestly believe there is a moral aspect to the concept of taxation. Again, I don't like paying taxes, and I grouse around for a day or two after receiving my tax notices from the county, or after I find out that I OWE the feds a few hundred more dollars. BUT when I calm down and take the time to analyze what I'm doing, I realize once again that when I pay my taxes I am simply fulfilling one more of the OBLIGATIONS that I have to this society and to my fellow citizens by paying those *(&%$! taxes. I'm willing to pay my fair share. I wish everyone was.

Posted by: Ron Rookstool | Sep 24, 2016 08:29

Very well stated, Mr. Sanderson. Wish I had your writing talent.

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