GREENSBORO, N.C. — For the last decade, it has been the hottest debate in our state, and Wednesday it could be a done deal.
Lawmakers at the General Assembly say they have reached an agreement to expand Medicaid.
North Carolina’s Department of Health and Human Services says that means about 600,000 more people are about to get health insurance across North Carolina. That's about one out of every 17 of your neighbors.
Who is included in the change?
To understand the change, let's start with the current system.
Right now, to qualify for Medicaid you must have a low income and meet one of these other qualifications:
- Be pregnant
- Be responsible for a child under 18
- Be blind
- Have a disability, or have a family member living with you who has a disability
- Be 65 or older.
Under Medicaid expansion, the only requirement would be to have a low income. According to healthcare.gov, the new threshold would be: anyone who makes up under 138% of the federal poverty level would qualify. That means about $20,000 for a single person, 27,000 for a family of two, $34,000 for a family of 3, and $41,000 for a family of 4. The numbers will be a little different depending on which county you live in, but they should be somewhere around these amounts.
According to NC Child, workers in the construction industry, retail, and food services are most likely to benefit from Medicaid expansion.
Impacts on our state
Simply put: more people with health care coverage means fewer people dying. Research from the University of Michigan found after other states expanded Medicaid, they had an average 9.4% decrease in the number of people dying every year. That's part of the reason doctors and healthcare professionals have backed Medicaid expansion for a long time.
“Heart disease, stroke, cancer. Name a condition and that advocacy group supports Medicaid expansion because we know it can improve health in North Carolina,” said Peg O’Connell with Care 4 Carolina.
Research also shows when more people have health insurance, it frees up money for them to focus on other needs. The amount of food insecurity drops after Medicaid expansion. There are also fewer people who get evicted.
So, about 12% fewer people file for bankruptcy. There are also fewer late child support payments. And one that impacts everyone in the state: there's a reduction in violent crime in places that have already expanded Medicaid.
Why now?
39 other states have already expanded Medicaid over the past decade.
Democrats in North Carolina always wanted to do it. Republicans were holding out saying it could put a serious financial strain on our state. So why after all time have Republicans changed their minds?
It mostly has to do with money and how much of it is coming from the Federal government. The Federal government has always offered to pay for 90% of the expansion leaving North Carolina to cover the remaining 10%. Yet, Republicans were worried that one day the Feds would stop sending that cash stiffing us with the bill.
Now, that we've been through President Obama's administration, President Trump's, and President Biden's with the federal government still offering the same level of funding, North Carolina Republicans felt it was safe to move ahead.
Plus, the Federal government has sweetened the pot offering even more money: a $1.5 billion bonus for expansion plus an extra $800 million every single year after that. Money that's not tied to healthcare. It can be used for anything the state wants.
Also, as part of approving Medicaid expansion, Republican lawmakers were able to negotiate a deal that would all more competition between hospital systems to hopefully drive down healthcare prices for everyone.
What’s next?
After the General Assembly passes its new plan, it will go to Governor Roy Cooper. He was not part of negotiating this deal, but he has pushed for Medicaid expansion for a long time.
After the news broke, he tweeted:
An agreement by legislative leaders to expand Medicaid in North Carolina is a monumental step that will save lives and I commend the hard work that got us here. Since we all agree this is the right thing to do, we should make it effective now to make sure we leverage the money that will save our rural hospitals and invest in mental health. I look forward to reviewing the details of the bill.
Republican leaders say Medicaid expansion will be included in the state budget, so it should start after that's approved sometime this Summer.