Medicaid Expansion

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The community we turned to for our second report on poverty in North Carolina is not a place so much as a condition--a health care condition called the "Medicaid gap." People suffering from the Medicaid gap do not qualify for traditional Medicaid (most working age adults who are not blind or disabled do not qualify) nor can they afford insurance under the ACA (aka "Obamacare").

This odd state of affairs arose because the ACA originally contemplated a mandatory Medicaid expansion that would cover all poorer adults. When the US Supreme Court ruled that the Medicaid expansion was voluntary, some states, including North Carolina, opted to reject expansion (despite the feds offering to pay for almost all of it). As a result,
over half a million Tar Heels are too rich for traditional Medicaid and too poor to receive subsidies under the ACA.

As described in our report, Putting a Face on Medicaid Expansion in North Carolina, the consequences of refusing to expand Medicaid are many. They are certainly economic. The state loses out on billions of dollars of federal funding, thousands of new jobs, and the bountiful economic stimulus this activity creates.

But the true crisis is a personal one. Lives are stunted and cut short by the lack of access to health care. Our report includes interviews with doctors, patients and would-be patients who are witness to--and struggling with--the consequences of the state's decision to deny expansion. As Gene Nichol states, the decision to turn down Medicaid expansion, "touches, dramatically and unforgivingly, the fabric, character, dignity and humanity of North Carolina life."

Read op-eds on the harm done by the state's refusal to expand Medicaid by Gene Nichol, Dr. Charles van der Horst and NC Policy Watch's Chris Fitzsimon. This brief but pointed Vice News video explains the Medicaid gap and features a doctor we interviewed extensively for our report.

Percent uninsured by county (click on a county for more information)

Source: 2016 ACS 5-Year Estimates
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