Medicaid coverage gap is a disgrace to the state's god name

By Steve Ford | Oct 31, 2013

Isn’t the federal Affordable Care Act supposed to help low-income Americans obtain the health insurance coverage that has been out of reach for millions? To be sure, that’s the idea at the heart of the law everyone now refers to as Obamacare. And despite frustrating hang-ups in online enrollment, the law will enable many folks to join the ranks of the insured.

Yet many other people who probably can’t afford any coverage at all will be flat out of luck. In North Carolina, the decision not to expand eligibility for Medicaid – expansion that was seen as a key Obamacare feature and lifeline – has resulted in the cruel irony that some of our neighbors are too poor to qualify for a program meant to help the poor.

Ours is one of 26 states that have exercised the prerogative granted by the U.S. Supreme Court not to enlarge their Medicaid programs despite the Affordable Care Act’s requirements. Conservative critics of the reform law, such as Gov. Pat McCrory and his fellow Republicans who control the General Assembly, view Medicaid as too expensive and don’t want to bring more people under that umbrella – even though the federal government would shoulder almost all of the cost.

So now North Carolinians paying federal taxes get to help pay for Medicaid expansion in other states. They also face health insurance premiums driven even higher by the cost of providing emergency and charity care to low-income, uninsured patients for whom Medicaid remains off-limits.

People who already have health insurance through their jobs won’t be sweating the details of Obamacare – unless, perhaps, they’ve gotten sick and are threatened with a loss of coverage, or are thinking about changing jobs and are worried about coverage for a pre-existing condition. Under the new law they’ll have some protection.

For those who have to buy health insurance on their own, not through their place of work, the law offers tax credits subsidizing the cost – provided the buyer’s income is above the federal poverty level. But for people who make little money, coverage will be hard to afford even with subsidies. So Obamacare is designed to bring those whose income is no more than 138 percent of the poverty level – just shy of $27,000 for a family of three – under Medicaid.

A hurtful fall

Uncooperative states, such as North Carolina, are left with many people who qualify neither for subsidies nor for Medicaid as the program now operates. They fall into a “coverage gap” that wouldn’t exist but for the senseless, heartless decision by the legislature and governor to deprive them of help they were supposed to get.

Medicaid is a crucial safety net for low-income parents and the disabled. But in North Carolina a non-disabled, poor adult without dependent children isn’t covered.

If he or she needs to see a doctor, it’s off to the charity clinic or the hospital emergency room, where the costs of care end up being shifted to patients with insurance. Needless to say, the ongoing level of medical attention such a person receives typically doesn’t match what an insured patient expects. Health consequences can be serious.

The Kaiser Family Foundation figures that more than five million low-income Americans who would be brought under Medicaid if states expanded their programs instead will remain in the coverage gap. In North Carolina 318,710 people will be affected, the foundation estimates. Click here to read the group’s recent brief.

Kaiser’s breakdown paints a stark picture of poverty-stricken North Carolinians for whom regular health care must seem like a dream. To qualify for Medicaid, a family of three can have an annual income no higher than $8,861. Without children living at home, non-disabled adults don’t qualify, period.

According to Kaiser, those 318,710 folks in the coverage gap represent 28 percent of all North Carolinians without health insurance (taking senior citizens, who are eligible for Medicare, out of the equation).

They also represent 58 percent of the state’s low-income, uninsured adults, defined as those with annual earnings no greater than 138 percent of the poverty level. And they represent a stunning 91 percent of those who make no more than 100 percent of the poverty level – in other words, the really poor.

Think about it – even with the Affordable Care Act now in effect, 91 percent of North Carolinians in most desperate need of health insurance coverage still won’t find it the slightest bit easier to get! No wonder the NC Council of Churches regards Medicaid expansion, along with broader access to affordable health care in general, as a core social justice issue.

Hospitals on the edge

The state’s hospitals, especially those that count on a flow of Medicaid reimbursements to help them meet expenses, have favored the program’s expansion. And they’ve warned that having to cope with an ongoing stream of uninsured patients could drag them down.

Vidant Health’s 60-bed hospital in Belhaven, north of the Pamlico River in Beaufort County, was struggling financially with an aging facility even before the Medicaid decision in Raleigh. But having to do without more Medicaid revenue appears to be one reason why Vidant, despite community protests, has scheduled the hospital to close. It will be replaced by a multi-specialty, around-the-clock clinic, but there will be no in-patient beds.

North Carolina has done good work trying to upgrade the level of health care in its small towns and rural counties. The medical school at East Carolina University, for example, has been at the forefront of this effort. But a refusal to let the Affordable Care Act work as it was intended now represents backsliding that poses actual harm to many of the state’s low-income residents. Count those who have relied on access to the hospital in Belhaven as also among those bearing the burden of state leaders’ obstinacy.

Gov. McCrory could go far toward atoning for some of his first-year misjudgments if he would acknowledge the benefits of Medicaid expansion and put it back on the agenda for the legislature to consider. The health insurance coverage gap as it now stands in North Carolina is unnecessary, inhumane and a disgrace to the state’s good name.

Steve Ford, former editorial page editor at Raleigh’s News & Observer, is now a Volunteer Program Associate at the North Carolina Council of Churches. This essay appeared originally appeared on the Council’s website.

Comments (6)
Posted by: Charles Zimmerman | Nov 01, 2013 06:21

        Thank you for an honest fact filled report.


         Chuck zimmerman

Posted by: Gary Arrington | Nov 01, 2013 12:59

I agree that North Carolina needs to expand its Medicaid program. Our federal tax dollars are going to other states. In my opinion, there's no need to keep opposing will eventually collapse under its own weight. If they can't run a website, they surely can't run 1/6 of the nation's economy.

I did feel that the author went off track at one point. He said "People who already have health insurance through their jobs won’t be sweating the details of Obamacare". This seems like the same old rhetoric we've been hearing ..."You can keep your insurance if you want it".  The fact is, many people who have insurance through their employers are finding that their premiums are increasing or their plans are being cancelled and they're being sent to the exchanges. In addition, NBC disclosed this week shocking news about how many individual buyers of health insurance will lose their coverage. Here's the link:

Posted by: Scott Lilly | Nov 01, 2013 15:09

I second that, Gary!  My employer's cost for providing my health insurance went up about $200/month.  They passed the increase in cost on to me.  As far as I can tell, I have no added benefit -- just added cost.  Thanks Obamacare.  IT'S A SCAM!

Just as bad is government deciding that they can "declare" all of Hazelwood a flood zone and increase costs for mortgages for flood insurance.  My house is 92 years old and never flooded.  Yet the government says every 100 years my house will be 2 feet deep in water.  And if I want to challenge them on the grounds of common sense, I need about $6,000,000 to fund an area geological study.  HOGWASH!

Or just like Social Security -- you pay all your life into a "benefit" and if you're lucky enough to live to start drawing out of it, you typically take out nowhere near what you put into it.  IT'S A PONZI SCHEME!


Posted by: Charles Zimmerman | Nov 02, 2013 11:57

       Of course Social Security or any govt. program funded by "all persons" but placing restrictions on who or why anyone gets any bennifit especially if one of the restrictions is age, is a 'PONZI SCHEME"! It relies in part on a percentage of those paying in dieing before any bennefit is pulled out. In the past a large base paid the way for a dwindling minority of surviviors. But because of increasing life spans the point of the pyramid is expanding. AND! With the bush tax cuts being used by the top 5% to undermine US and tax laws whereby WE the people subsidize jobs being "outsourced" overseas, "trickle-down" stealing money from the middle and lower classes to reward the top 5% for providing jobs in return, BUT! with no stated requirements that the 5% actually do so, etc, the large base of tax-payers has dwindled.

        We can reverse this.

SS taxes should be assessed against all money earned. For too long earnings over app $100,000.00 have not been assessed to support SS. This results in those earning less paying more than their fair share while those earning over the cut-off gain exponentially as income rises. Talk about "takers"!

bush tax-cuts rescinded and recollected with interest and penalties collected on any and all US taxes being used not in support of US jobs.

Taxes being assessed in such a way that each pays in proportion to their ability to pay. No deductions whatsoever.

 All transactions whereby money or goods are exchanged whether directly or in the future, taxed. "Swaps" are by and large not taxed now. This gives an advantage to unbridled money-changers whereby they can turn over a clients account dollars many times without any cost of responsably paying taxes to US.

Rescind any law that subsidizes any company that outsources jobs overseas. What anti-American ***** had such a law passed in the first place?

Fine and/or imprison anyone who "harvests" OUR companies. I was in Kansas City when mitt romney swooped into town and shut down a certain and particular steel mill with the intent of moving the buisness overseas while retaining assets such as pensions to be sold later.  I had done a favor for Weirton Steel by hauling steel coils to Kansas City with a return load back to Columbus, Ohio area. Except that it was from the very mill romney shut down! This anti-American action was like a nuke going off with the effects rippling thruout the freight industry. There was nothing to be hauled, anywhere. Cost me $1,300.00 to go back to Weirton, W.Va empty. As it literally took the air out of the freight buisness, things were slow for some time afterward. Many industries cut back on orders. This gave receivers the leaverage to cut rates on shipping, directly affecting my income. And. Several of the best customers went with cheaper cariers. I had to counter by delivering to places I'd previously prefferred not to. Cost me and Owner Operators greatly. Led to cut-throat trucking companies gaining market share.

Etc, Etc.


       Barb and I are currently paying app. $430.00/month for healthcare. 'Blue sent a notice raising our rate to app.$1,300.00/month claiming "obamacare"! I have a complaint in with NC Attourney General with no expectation of respnse. By the exchange and with subsidies, we will be paying app. $330.00 for better coverage.


          We the people acting together are the solution to OUR problems.

           Govt. by the people for the people is not just a bumper sticker.


             Chuck Zimmerman

Posted by: Scott Lilly | Nov 04, 2013 16:09

Mr. Zimmerman, I do enjoy reading your posts.

Who gets to define "fair share"?  If I pay into a system more than 150% of what I will take out of the system, have I paid my "fair share"?  If someone takes out more than they put in, did they pay their "fair share"?  My point is that once government has the power to define these kinds of things, nothing good can come of it.

How do you define "black" - as was used to discriminate against color long ago?  How do you define "healthy" as government is starting to do now so as to penalize people for being something other than that?  Defining "wealthy" is a slippery slope - the end result of that is the wealthiest 49% of Americans have their wealth voted away by a 51% voting majority taking their wealth.  A Republic form of government is supposed to protect against that -- against ANY voting majority taking advantage of a voting minority no matter what the discriminating measure is.

If your health insurance costs you $1,300/month and you'll be receiving assistance/subsidies for a great portion of that, what does paying your "fair share" for health insurance mean to you?

Posted by: Charles Zimmerman | Nov 05, 2013 08:26



        Thank you.

         First off, OUR Founders most certainly created a representative secular republic, whereby WE elect people to represent US and do OUR buisness while WE retain OUR Naturally inherent or otherwise inalienable rights and thus can challenge any law passed that harms US.  To that end OUR representatives are tasked with determining what the tax rates are bearing in mind they cannot violate the Founding Principle of equal protection without leaving any law passed open to challenge by any taxpayer as to "fair share". James Madison quite well handled the issue of balancing one person or group's rights against another "faction" in Federalist No. 10, among other places. He warned about the accumulation of too much wealth/power in too few hands in a permanent fashion(inherent bondsmen) in Detached Memoranda.

                 George Mason's Article 1 of the Virginia Declaration of Rights clearly stated:"That all men are by nature equally free and independant, and have certain rights,...." This was used by Jefferson as the primary basis for the Declaration of Independance and by Madison as the cornerstone of the Constitution and Bill of Rights. However, because of resistance by slave holders, "free men" was embraced. There were slaves from many backgrounds/countries including "endentured servants" who paid their way by selling themselves. There were minorities that were considered "free men". Single women by and large had same rights as men, with married women being under the safety of their spouse. Abortion was legal. Skin color had little to do with condition of Liberty anyone chose to accept. One of the things that Jefferson didn't like about his "slaves" was that they didn't rise-up and challenge their freedom. That freedom must be fought for. Continuously. I read somewhere that he thought that no "slaveowner" should sleep without fear of having his throat cut, if his slaves had the courage to do so. Because Jefferson thoutght they should, he treated them quite well, everything considered.

                 The 14th Amendment embraced "All persons". This should have been the end of discrimination. Unfortunetaly, not everyone agrees that "All persons" is self-explanatory and is inclusive. To this day people are still trying to be considered as to "All persons".

                 Myself, personally, I don't like insurance. It is an organized crap-shoot. Gambling pure and simple. Having been a farmer most of my life I know full well about gambling. Sometimes I judged the weather about right. Sometimes not. I paid the price for error. Considering life in of itself is a gamble with no guaranteed outcomes day to day or any other way, I have always believed all should be responsable for themselves and pay for what they can afford. Unfortunetly, with the embrace of "trickle-down" whereby the masses by and large gave of themselves to the better-off in the hopes of being "trickled" on, a huge amount of wealth has been transfered to the better-off with little to show for it. Add outsourcing, etc and this has resulted in a large amount of people unable to provide for themselves let alone health care. ACA to some degree has addressed this in-equality. Will it be enough to prevent anarchy, crime, etc when there are large disparities in Society? I doubt it. People, unable to provide for themselves/family, with nothing more to lose than their life, have always risen-up against their oppressor. Perceived or otherwise.

             In my case, considering the manner Nixon, Carter, "rayguns" manipulated the grain market, which is why support payments were neccessary, costing me untold amounts of income, I don't mind being "subsidized". I can't speek to anyone else's particular situation.


           Chuck Zimmerman

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