Medicaid expansion will benefit tens of thousands of people, especially throughout WNC. The refusal to expand it threatens hospitals and families.

Above: a doctor holds a sign supporting Medicaid expansion at a Moral Monday protest. Photo by Leslie Boyd.

Imagine living in a place where 17,000 people die in a year because they don’t have access to health care. That’s about 47 people a day.

People are dying from curable, treatable causes like asthma, advanced cancers, complications from diabetes and high blood pressure. If they had the modern care we in the United States pride ourselves on having, they would survive. Screenings could detect cancers early when they’re treatable, asthma and high blood pressure, diabetes, mental illnesses all could be managed with medications and simple regimens and screenings. Suffering could be minimized.

But the suffering goes on because these poor people can’t get the care they need.

This place exists, and it’s not some third-world country, it’s here in the United States, where 22 states, including North Carolina, are turning down billions in federal dollars to expand Medicaid to all people with incomes below 130 percent of the federal poverty level.

This decision doesn’t just affect people who are poor and uninsured, it affects all of us.

The Affordable Care Act was written assuming every state would expand Medicaid, but the Supreme Court said Medicaid is an opt-in program, so its expansion must be as well.

In the law, though, money that used to go to hospitals and clinics for “indigent care” was put into the Medicaid expansion pot, so states that don’t expand Medicaid don’t get that money.

We’re still paying into that pot, but our money is going to states like Kentucky and Arizona, which did accept Medicaid expansion. Our hospitals and clinics, which had been reimbursed much of the money they spent on treating people who couldn’t pay, have seen that money disappear.

Budgets are stretched to the limit, so hospitals must respond with program cuts, layoffs and even closings. These cuts affect all of us, not just the most vulnerable among us.

In Belhaven, after the local hospital closed July 1, Portia Gibbs died while waiting to be transferred to the next closest hospital some 70 miles away. She will not be the only casualty.

In North Carolina, up to a half million people are without insurance because they are too low-income to qualify to go through the insurance marketplaces and they don’t qualify for Medicaid unless it is expanded. It’s estimated that up to 2,800 of them will die this year – almost eight every day.

In states that have expanded Medicaid, more people are insured, which means more people are getting the care they need for chronic conditions, and that leads to lower costs over the course of several years because there will be far fewer expensive complications.

In states that have expanded Medicaid, coverage has increased by two or more times that in states that have refused the expansion.

Let’s look at a couple of districts, one in North Carolina, which has not accepted Medicaid, and one in Kentucky, which did expand it. Both districts are largely rural and are represented by Republicans.

In District 11, represented by Mark Meadows (R):

• 17,100 individuals who were previously uninsured now have quality, affordable health coverage.
• Overall, the number of uninsured district residents has declined by 14 percent;
• 28,600 got insurance through the new health insurance marketplace and 5,900 young adults were able to retain coverage through their parents’ plans.
• For 91 percent of those in the marketplace, financial assistance reduced the cost of the average plan to $81 per month.
• 30,000 people in the district who would otherwise be covered remain uninsured because the state has refused to expand Medicaid.

In Kentucky District 4, represented by Thomas Massie (R):

• 31,000 district residents who were previously uninsured now have quality, affordable health coverage.
• Overall, the number of uninsured district residents has declined by 34 percent.
• About 12,500 people purchased coverage through the new health insurance marketplace, 39,100 enrolled in Medicaid, and 6,800 young adults were able to retain coverage through their parents’ plans.
• For the majority of those enrolled in the marketplace, financial assistance was available that substantially reduced the cost of coverage – in many cases to less than $100 per month.
• 294,000 individuals in the district – including 68,000 children and 116,000 women – now have health insurance that covers preventive services without any co-pays, coinsurance, or deductible.

So, in the 11^th Congressional District alone, some 30,000 people are without access to health care. The region’s medical center, Mission Hospitals, will lose tens of millions of dollars this year and is already announcing layoffs and program cuts.

This affects all of us, even those of us who have good insurance. The care available to us here in this state is declining because the majority of members in our General Assembly refuse to accept federal money to care for those who can least afford to care for themselves.

It’s time to change this, to expand access to care so that all people can get what they need. It should be a basic human right, not just a perk offered to people who are fortunate enough to live in Kentucky or Arizona or the other states that have expanded Medicaid.

Find out how your representative or senator voted on this and let them know their vote will affect your vote come November. Register and vote.

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Leslie Boyd is the founder and president of WNC Health Advocates.

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