Medicaid expansion promises to be a vital addition for Jackson’s uninsured

By Beth Lawrence

After years of debate and political maneuvering, North Carolina has finally expanded Medicaid. With an asterisk.

On March 27, Governor Roy Cooper signed HB76 into law. The new law, which received bipartisan support, expands Medicaid eligibility for residents who earn too little money to obtain insurance coverage elsewhere but who previously did not qualify for traditional Medicaid.

"Medicaid expansion is a once-in-a-generation investment that will strengthen our mental health system, boost our rural hospitals, support working families and so much more," Cooper said. "This is a historic step toward a healthier North Carolina that will bring people the opportunity of better health and a better life."

However, there is a caveat. While parts of the bill went into effect upon Cooper's pen stroke, the crucial part of the bill, giving people without insurance access to much needed healthcare, does not go into effect until the state passes a balanced budget. While that may seem like a straightforward proposition, passing a budget in North Carolina has become a political chess match in recent years with stalemates dragging out the process sometimes leaving local governments and others dependent on state funds or guidance in financial limbo.

The step is still a hopeful one, especially for agencies working to improve healthcare in the region.

Brian Huskey, executive director of Great Smokies Health Foundation knows only too well the impact lack of access to healthcare can have.

"I obviously have a professional interest in seeing Medicaid expansion, but it's also personal for me," he said. "My friend Chris died last year from a highly treatable cancer that would have been easily diagnosed had he been seeing a doctor regularly. He'd worked hard his whole life, but could never afford private insurance, never worked for a company that offered it, and could never afford a regular annual check-up. So, by the time he was so sick that he went to the emergency department at the hospital, it was just too late. He died two weeks later. But if he'd been able to access care from a Medicaid expansion, I wouldn't have lost one of my best friends of almost four decades."

People like Huskey's friend are exactly the kind of people Medicaid expansion is designed to help.

Medicaid and children's health insurance are a federal system of health insurance for low income persons. There are currently some stipulations for eligibility such as income and having a disability.

Despite the trope that Medicaid is for those who won't work and who are a drain on taxpayers, the opposite is often true. Those who would qualify under expansion are working people who simply do not earn enough money to afford insurance or who do not have access to employer-provided coverage.

Qualification for Medicaid depends on household size and income. Typically, a household must be at or below 133 percent of the federal poverty level. That disqualifies many people who work, whether part or full time. For example, a single, childless, receptionist working full time who met other qualifications must earn no more than $14,580 annually. If that receptionist earned over a certain amount, he or she would not qualify for ACA insurance and would earn too much to qualify for Medicaid under previous guidelines.

"Most of them are working poor people who make too much to qualify for subsidies that are available in the ACA Market Place, and in some cases, they make too much to qualify for Medicaid," Huskey said.

Expansion could likely help the 21 percent of Jackson County residents who currently do not have healthcare coverage, giving them access to medical care they would likely be unable to afford otherwise.

"Even if they end up in the emergency room where the emergency room has to take care of you, if you don't have insurance coverage an ER visit can cost several thousand dollars, depending on what you go in for and what they test you for," Huskey said.

Often people live with a condition until they wind up in an emergency room. But even an emergency visit does not provide adequate treatment for someone with a long-term condition such as heart disease or diabetes. Frequently these patients cannot properly manage their conditions after leaving the hospital.

"That drives healthcare costs up (for everyone)," Huskey said.

Benefits of expansion could also extend to reduced medical costs for all because uninsured patients won't wind up in doctors' offices and hospitals facing bills they cannot hope to pay. When that happens, those unpaid costs are passed on to others who can pay.

Jackson County residents who will receive coverage under expansion have an added benefit.

They are "lucky" because Harris Regional and Swain Community hospitals are already in network with all Medicaid Managed Care plans, and those hospitals have a number of specialty care providers, Huskey said.