With Obamacare affirmed, it’s time for a plan to cover 500,000 North Carolinians

With Obamacare affirmed, it’s time for a plan to cover 500,000 North Carolinians

- in Progressive Voices

Medicaid-Funding0915[Editor’s note: In the aftermath of yesterday’s momentous U.S. Supreme Court ruling in the case of King v. Burwell sustaining a key provision of the Affordable Care Act, the health insurance coverage currently enjoyed by more than six million Americans across 34 states is now secure. In North Carolina, more than 400,000 people receive much needed financial help to make health insurance more affordable and yesterday’s decision means they will maintain access to these tax credits.

Unfortunately, this is far from the end of the story. Hundreds of thousands of North Carolinians of modest means remain trapped in a “coverage gap” in which they are too poor to qualify for ACA subsidies but too “well-off” to qualify for Medicaid.

As Adam Linker, Co-Director of the North Carolina Health Access Coalition, explains in the following essay, which originally appeared as a post on the The Progressive Pulse blog yesterday, this needs to change. State leaders need to formulate a plan ASAP (prior to the adjournment of the current legislative session) to close this absurd and unnecessary gap, provide peace of mind to hundreds of thousands of people and literally save hundreds, if not thousands, of lives.]


Now that the Supreme Court has ruled — again — that the structure of the Affordable Care Act is constitutional, it is time to move forward with making the law work better in our state.

The first, and most important, step is accepting federal funds to extend the benefits of affordable health insurance coverage to 500,000 more people in our state. Gov. McCrory said last year that his staff was assembling options to expand coverage and that he would make an announcement about his recommendation after the Supreme Court ruled in King v. Burwell. The ruling has arrived.

When asked about expansion today McCrory was sort of squishy and said he wants a North Carolina plan. We all do. But first we need the Governor to draft and release such a plan. Conservative Governors in Ohio, Indiana, Utah, Michigan, Tennessee and other states have either closed the coverage gap or assembled a strategy to accomplish a coverage expansion. There’s no reason our Governor can’t do the same.

Legislators are still critical of expansion. Sen. Ralph Hise says that he doesn’t think the federal government will be flexible enough to allow a state option. His wish list includes wanting to expand using private insurance and imposing co-pays on recipients above the federal poverty level.

Of course, the federal government has approved even more conservative measures than Hise mentions. Several states including Arkansas, Iowa, and Michigan do use private insurance to expand coverage. Some states are charging co-pays and premiums even on enrollees earning less than the federal poverty level. The federal government has shown a degree of flexibility that makes many advocates uncomfortable. The idea that our hands are tied is, to quote Justice Scalia, pure applesauce.

Recently released data from the National Health Interview Survey show the dramatic impact of expanding coverage. In Kentucky the adult uninsured rate dropped from 24.1 percent in 2013 to 15.6 percent in 2014. In Arkansas the rate went from 27.5 percent to 15.6 percent. And, most stunningly, in West Virginia the adult uninsured rate went from 28.8 percent in 2013 to 12.2 percent in 2014. These numbers reflect only the first year of expansion and states nearly cut their adult uninsured rates in half. In North Carolina the adult uninsured rate moved from 25.6 percent to 22.5 percent.

A majority of states are expanding coverage while reforming their Medicaid programs. More states will join their ranks now the Supreme Court has ruled that the Affordable Care Act is here to stay. The Governor must show leadership on this issue and ensure that all of our citizens have access to comprehensive, affordable health insurance.