All of a sudden, Medicaid expansion is a big topic in Raleigh, North Carolina. Senate Democrats are pushing a bill, and New Hanover County's Sen. Harper Peterson thinks it's a good idea. We do, too. Even Republicans in the legislature are getting in on the act. (More on that in a minute.)
Ignoring the fact that several hundred thousand of our fellow Tar Heels do not have health insurance does not make the problem go away. And don't think that just because you have insurance you are not negatively affected, especially if you live in a rural area.
Medicaid (not to be confused with Medicare) is a federal program but is managed at the state level. In North Carolina, it's run by the state Department of Health and Human Services. Medicaid provides benefits for poor children and for a narrow cadre of the aged, the poor, the disabled and pregnant women. It costs $14.8 billion or so a year, with Uncle Sam covering two-thirds of the costs.
This is nice, but it leaves a whole lot of folks — most of whom have jobs — too poor to afford health care, too rich for Medicaid and not covered by their employers. It's estimated to be more than 300,000 adults.
Why should this worry us? Well, basic humanity aside, a lot of these people have chronic health conditions that aren't getting treated. Cancers aren't detected, high blood pressure turns into strokes, diabetes turns into amputations.
A lot of these folks wind up in emergency rooms for needed expensive care they can't afford. (Federal law requires those emergency departments to treat them.) The cost of that care then gets passed on to other patients — one reason why medical bills are so high. Emergency departments become the de facto health care option for earaches and sore throats, often leaving them overcrowded and plagued by long waits.
The Affordable Care Act (yes, the dreaded Obamacare) offered states an option: If a state would extend Medicaid coverage to folks earning less than 138 percent of the federal poverty line, Uncle Sam would cover all the costs initially and then pick up 90 percent of the tab.
(For the math-challenged — ourselves included — 138 percent of the poverty line amounts to a little more than $17,000 for one person and $29,435 for a family of three.
It seems like a sucker's deal. One way, Uncle Sam pays for two-thirds of Medicaid. The other way, he pays for 90 percent. What could be simpler?
Well, a lot of Republican-run states, including North Carolina, didn't like the idea — or anything else associated with Obamacare. They refused to expand, so we pay the tax dollars for it but receive none of the benefits.
Some red states held their noses and took the plunge, sometimes by adopting elaborate plans without using the term "Medicaid." (Indiana did something like this while Vice President Mike Pence was still governor.)
So now, the Democrats are pushing expansion, but they're the minority in both houses of the legislature.
Enter a small group of Republicans with a plan called Carolina Cares. It would expand Medicaid, but with some conditions: The new additions to the Medicaid rolls would have to pay a monthly premium. They'd also have to a) hold a job, b) be looking for work or c) be in a job training program.
That's not ideal. When you're not far above the poverty level and living paycheck to paycheck, a lot of folks are likely (yes, unwisely) to skip the premium. Then they get sick, and we pay for it. Also, even today, finding a job in parts of this state is harder than it might seem. Most areas of North Carolina are not enjoying the same low unemployment levels and economic prosperity found in Wilmington and other urban centers.
Still, Carolina Cares is a step in the right direction and is an acknowledgment by at least some Republican legislators that the status quo is untenable. (Among the side effects of that status quo are the closure of rural hospitals and lack of other vital health services and practitioners).
Carolina Cares got nowhere in the last session, but House Speaker Tim Moore seems to be making noises that he thinks better of the plan and is willing, at least, to discuss it.
This difficult issue will be hotly debated, but we hope the Republican leaders will at least let the debate take place. There are positives and negatives in both proposals, but all sides need to be heard, and the public should be given an opportunity to weigh in.
The days of turning a blind eye to the health insurance gap need to be over.
REPRINTED FROM THE NEW BERN SUN JOURNAL