You’ll remember that earlier this year, Governor McCrory and state legislative leaders refused to expand Medicaid as called for under federal health reform. The expansion would have extended health coverage to about 500,000 North Carolinians living in or near poverty.
When the health care exchanges open next week, they will provide access to affordable insurance to tens of millions of people across the country– but those 500,000 folks in North Carolina still won’t get coverage. Only people making more than 138% of the federal poverty level will have access to the subsidies that help pay for insurance—because the Affordable Care Act assumes that people making less will get coverage through the Medicaid expansion.
State leaders’ decision not to expand Medicaid could signify a death blow to rural hospitals in North Carolina. North Carolina’s rural counties have fewer people but much higher rates of poverty than its urban areas. So those rural hospitals see a greater share of patients without health insurance.
The federal government has always subsidized rural hospitals, but that money will now go away since all of those poor and uninsured patients should have received Medicaid coverage.
The executives of one rural hospital in coastal Beaufort County – poverty rate 22.3% — announced earlier this month that it is closing, “pointing to North Carolina’s decision not to participate in federally funded Medicaid expansion” as the reason.
It likely won’t be the last. As health economist Tim McBride said at the National Rural Health Association conference, “Not expanding Medicaid … is a rural issue.” He added, “I don’t see an upside to not expanding. The truth is, this will be really important money for rural hospitals, rural health providers, and rural communities.”
And without it, more rural hospitals in North Carolina will close their doors.