Closing Medicaid coverage gap can't wait Karen Alexander and Patrick Woodie: Closing the coverage gap can't wait

Hundreds of thousands of Tarheels cheered in June when the N.C. Senate overwhelmingly approved a much-needed plan to expand Medicaid and close our state's deadly health insurance coverage gap.

From our cities to our rural regions, they were also encouraged when the N.C. House passed its Medicaid expansion plan. But now, the immense relief felt by so many is fading.

The legislative chambers have yet to reach an agreement on a solution that works for both of them. And until they do, North Carolinians in our downtowns, small towns, and everywhere in between will remain stuck in the coverage gap. Furthermore, rural constituents are disproportionately uninsured compared to their urban and suburban counterparts. In fact, 20 of the 22 North Carolina counties with the highest percentage of uninsured constituents are rural counties.

The gap swallows up people who earn too much to qualify for Medicaid, but too little to qualify for a subsidy on the health insurance marketplace. For example, many North Carolinians clock in to jobs day after day, and yet don't have access to health insurance.

Prior to the pandemic, approximately 400,000 North Carolinians lacked access to affordable health insurance. Now, The Kaiser Family Foundation estimates the number of North Carolinians who would benefit from closing the gap has grown by more than 200,000.

So far, 38 states have moved to close their gaps by expanding Medicaid, with the federal government paying 90% of the cost. Federal law dictates that this funding level will not decrease.

The American Rescue Plan provides states with a new incentive: a two-year, 5% increase in the federal match rate for Medicaid. For North Carolina, that would mean an influx of around $1.7 billion over the next two years. Official estimates put the cost of closing the coverage gap through Medicaid at $700 million over that span, which would leave $1 billion for the state to invest in other worthy endeavors.

This would not only be an incredibly good deal financially for the state, but also potentially lifesaving funding for hundreds of thousands of North Carolinians.

Medicaid funding is a key tool in screening for common diseases like cancer and fighting for recovery once a disease is detected. A recent study showed that cancer patients in "holdout" states like ours experienced lower survival rates - including a 31% increase in mortality risk among breast cancer patients.

Expanding Medicaid would help everyone, from the mom who hurries to put in part-time hours as a waitress while also taking care of her kids, to the pastor who leads a congregation which doesn't have the resources to provide insurance, to the 14,000 veterans without coverage in North Carolina.

Economic developers in favor of expansion say it will support and stimulate small businesses, many of which can't afford to offer insurance to employees while in the startup stage. For that reason, some fail to attract the talent needed to succeed. Even earlier in the process, some aspiring entrepreneurs decide the insurance gap is too great to overcome and opt not to start a business at all.

In states that have expanded Medicaid, the percentage of small business employees covered by Medicaid increased from 9.1% to 13.4% from 2013 to 2016; the number of self-employed individuals covered rose from 7.3% to 11.6% during the same time.

Consider, too, bigger businesses from elsewhere looking to expand. Among their highest priorities in scoping out a new market is a healthy workforce. Many North Carolinians live with diabetes, heart disease and other chronic illnesses, but can't access health care providers to manage these conditions. When workers are sick, they can't be as productive.

Polls show that North Carolina voters want to expand Medicaid. They came close to getting the support they want and need in June. Here's hoping that our state's leaders will fulfill so many people's hopes - in both our cities and rural regions - by closing the coverage gap.

Karen Alexander is the mayor of Salisbury and president of KKA Architecture, PA. Patrick Woodie is the CEO of the N.C. Rural Center.