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The Daily Tar Heel

Editorial: Legislative inaction means rural North Carolinians are without health care

Thirty-two of 33 developed countries have adopted universal healthcare, but can you guess which one hasn’t?

The United States currently runs on a health care system that allows for both governmental and private coverage. In 2010, Congress passed the Patient Protection and Affordable Care Act, which attempted to make health care mandatory for all citizens. 

However, a variety of exceptions allowed by the reform law, as well as states' ability to decide whether to expand individual government programs like Medicaid, led over 13 million Americans to go without health care. 

Thirty-seven states have expanded Medicaid in their legislative decisions, but North Carolina isn’t one of them. Even though over 500,000 North Carolinians would benefit from an expansion in Medicaid eligibility and access to affordable care, a lack of funding has made the timeline any potential policy changes unclear.

In June, Roy Cooper vetoed a $24 billion budget deal because the Republican-led General Assembly refused to include expanded Medicaid eligibility. If it were expanded, over half a million lower-income individuals could qualify for affordable care. 

Meanwhile, the state health department made different plans to move 1.6 million Medicaid recipients to a pay-for-value system early next February. But due to the disputes among the state government, the switch will likely be pushed back. This delay in the timeline may also be incredibly costly, and the pay-for-value system will likely hurt institutions in rural areas that may not have the means to serve patients at the highest quality of care.

For example, Rocky Mount is one of North Carolina’s most rural counties and faces some of the poorest health outcomes in the state. Leaders of Rocky Mount's community health center are worried that, due to their lack of resources, the new system will likely provide them with less Medicaid funding. This could prevent them from continuing to serve patients with chronic illnesses, housing instabilities and a variety of other issues.  

In addition, money isn’t the only issue — the process of enrolling for the new Medicaid plans is tedious, complex and only online. This puts individuals in rural areas at a severe disadvantage due to the lack of internet access and low literacy rates. The community health center itself has staffed employees who have been doing nothing but help patients with enrollment since the application opened up.

The indecisive nature of the state leaders, combined with an unclear future for Medicaid and health care, has led North Carolina to be ninth in the nation for the highest rate of uninsured residents. Over a million North Carolinians, about 10.7 percent of all residents, did not have health insurance during 2018. In addition, the state is one of 15 that saw a statistically significant jump in 130,000 children without insurance, almost 15,000 more than last year. 

Unsurprisingly, the rate of uninsured individuals in North Carolina is rising three times as fast as states that have elected to expand Medicaid. Officials have estimated that the expansion of Medicaid would potentially decrease the rate of uninsured individuals by 3 percent and lessen the stress on rural institutions like Rocky Mount’s community health center.

With a universal health care system under governmental regulation, the citizens of the United States can benefit from not only affordable care, but also strict drug pricing and higher care quality. In North Carolina, legislators can do their part by expanding Medicaid. This move would effectively lessen the high stress placed on rural healthcare providers and help over half a million underserved individuals get the affordable care that they need and deserve.

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