North Carolina became the 40th state to make Medicaid more available on December 1. Now, the state is still working to get more people to sign up for the service.
Adults in North Carolina between the ages of 19 and 64 who make up to 138% of the government poverty line can now get Medicaid. The insurance program pays for regular checkups and trips to the doctor, as well as medical, dental, and mental health care.
William Bleser, research director of health care transformation for social needs and health equity at the Duke-Margolis Institute for Health Policy, says that the fact that there are “uninsured and underinsured” people in the state means that Medicaid benefits and programs should be made available to more people.
Bleser says that this can be done “pretty much for free to groups that really need them.”
The N.C. Medicaid Expansion Dashboard was last updated on August 5. There are now 520,667 North Carolinians with health insurance through Medicaid, which is more than 21,000 more than in July. The full effects of the Medicaid increase have not yet been found.
The N.C. Department of Health and Human Services says that 273,000 North Carolinians signed up on the first day of the program’s expansion. “Most of those were part of the family planning population who were automatically moved to full coverage,” the department says.
Bleser thinks it will take at least a year to collect data and figure out the first effects of Medicaid growth because the program is still fairly new.
Bleser said, “Our health care is the most expensive per person in the world.” “Imagine being a low-income person who is struggling to pay their bills and keep the lights on. Then you get access to care that is almost entirely paid for. That’s amazing.”
From August 5 to August 9, 35% of people enrolled in Medicaid through the expansion were between the ages of 19 and 29. 62.4% of those who are enrolled live in cities, while 37.6% live in rural places.
Challenges to expanding health care access
Rebecca Whitaker, a research director at the Duke-Margolis Institute, said, “Medicaid coverage lets people get the health care they need, especially for long-term conditions they may have had before their state expanded Medicaid.” She used cancer care access and coverage as an example.
Whitaker thinks that the fact that a lot of people in rural parts of the state have signed up for Medicaid shows that efforts to reach out to those areas have been successful and that Medicaid helps these areas in particular. She did say, though, that North Carolinians living in rural places might still have trouble getting care even after they signed up because there isn’t enough infrastructure for health care.
Whitaker said that there is still a shortage of basic care workers, which she partly blamed on past underfunding and burnout from the COVID-19 pandemic. The American Medical Association says that because there aren’t enough doctors working, 83 million people across the country don’t have “sufficient access” to a basic care doctor.
Bleser says that some groups who didn’t have health insurance before and may have been “forced to forego years of care” don’t trust the health care system, which makes things even more complicated.
Some groups that didn’t have health insurance for years may not trust the system because they feel like it has let them down and failed them, Bleser said. One of the challenges for states that have added new Medicaid recipients is getting them to use the health system. This is because they may not be used to using it and may even be suspicious of it.
Barak Richman, the Edgar P. and Elizabeth C. Bartlett distinguished professor of law and senior core faculty member at the Margolis Institute, thinks that the NCDHHS is “really good job” of getting people in North Carolina to sign up.
Although, Richman said that Medicaid can only do so much to help fix health care inequality as a whole.
“Over the history of Medicaid, we have not seen any dents in health care disparities,” he said, citing an experiment in Oregon where giving a random group of people access to Medicaid increased their use of health care but did not have a statistically significant effect on their physical health.
Richman says that Medicaid should provide “financial assurance,” but “aggressive” hospital billing has made it hard for it to do so, causing the state to have medical debt.
Federal regulators accepted Gov. Roy Cooper’s plan to lower medical debt in July. This would give hospitals an incentive to pay off their patients’ medical debt. Cooper’s administration thought that the plan could help 2 million low- and middle-income North Carolinians get rid of up to $4 billion in medical debt.