Monday Numbers: Failure to expand Medicaid in NC hurts children


Hat-tip to Rob Schofield for keeping his eye on this ball:

39 – number of states (including the District of Columbia) that have expanded Medicaid
12 – number (including North Carolina) that have not expanded
53.8% – share of the uninsured children in the U.S. who live in those 12 states
38.2% – share that live in just four non-expansion states: Texas, Florida, Georgia and North Carolina

NC Republicans never had a good excuse for blocking this, but now they have nothing. Under the Biden administration's new push, the Federal government will cover 90% of the cost, and healthcare providers will cover the remaining 10%. For the mathematically challenged, that leaves Zero percent. The only thing that remains is a childish and irresponsible stubbornness to reject former President Obama's policies, however effective they might be. And as long as they continue to block this, their claims of being "pro-life" are pure hogwash:

Extending access to Medicaid coverage for adults benefits the whole family by providing continuous access to care and improving reproductive health. Medicaid expansion has been shown to improve preconception and prenatal care, including increased use of folic acid supplements, critical health screenings, and mental health services. Expansion is also associated with lower maternal and infant mortality rates.”

Another major factor that doesn't get mentioned enough is the closure of rural hospitals in states that haven't expanded Medicaid. Quoting myself from last Summer:

Those who live in the Triangle and the Triad may suffer from a lack of health insurance coverage, but the availability of treatment is seldom an issue. And those who do have insurance may be forced to choose from a selection of “in-network” providers. They may have to wait longer than they would care to for a scheduled appointment with their “specialist,” or even their primary care provider. While these issues may be frustrating, they are seldom life-threatening, because there’s always the ER. But what if you didn’t even have that option?

Since 2010, 108 rural hospitals have closed in the United States. Of the top ten states for rural hospital closures (Yes, NC is on that list), nine of them have not expanded Medicaid to close the coverage gap. That is not a coincidence, it is cause & effect. Those ten states are responsible for the closure of 73 out of the 108 rural hospitals, leaving hundreds of thousands without easy access to medical treatment. And there is no justifiable reason for that.

We keep seeing Republican leaders, who should know better, complaining about giving government assistance to those who are “able-bodied,” but that is pure rhetoric. Medicaid Expansion was designed to assist the “working” poor, not those who refuse to work. As absurd as it sounds, these are people who don’t earn enough to qualify for subsidies that are available to middle-class Americans. It’s an untenable situation that defies logic, but that’s what you get when elected officials are willing to use citizens to destroy a program they don’t like.

Back to the rural hospitals, and those abandoned rural families. In the absence of imaging, from x-rays to CT scans, they are left with speculation as to what might be causing them problems. With no labs to process blood samples, everything from high cholesterol to cancer can go undetected until it’s (way) too late. Pre-natal care and Ob/Gyn deliveries? Sorry, you’ll have to drive 100 miles to get that, and babies will come on their own timetable, even if you’re only halfway there.

You get the picture. Rural hospitals already cover a large geographic footprint, and every time we lose one of them, it represents a life-threatening crisis. North Carolina has already lost 5 rural hospitals, 2 of them in 2017 alone. Expanding Medicaid may not be a panacea that will replace those losses, but the numbers don’t lie. If we don’t take this obvious and critical step, that list will grow. And the number of North Carolinians suffering from lack of care will grow with it.

Just a footnote: #10 on that list I mentioned above is Kentucky, which was a late expander of Medicaid that attached work requirements until a court intervened.