Closing the health insurance coverage gap in NC 101

Expand Medicaid in NC

Under the Affordable Care Act, it was intended that every person have access to affordable health coverage. The law made it mandatory that states expand their Medicaid programs so that low-income people would be able to get Medicaid. But a Supreme Court decision gave states the option instead of mandating them to expand their Medicaid programs.

In 2013, Governor Pat McCrory and the North Carolina General Assembly chose not to expand Medicaid to those with incomes below 133% of the federal poverty line. Consequently, North Carolina today is among a minority of 24 states not receiving federal Medicaid expansion funding. Closing the health insurance coverage gap would provide health insurance to nearly 500,000 North Carolinians. These are the people that are in the NC coverage gap, they have no options for affordable health insurance.

Adults in North Carolina can get covered if they earn less than $5,700 a year. Those earning less than $16,242 don’t make enough to receive subsidies to help pay for insurance obtained through the Affordable Care Act marketplace.

“When patients become insured, they are better able to care for their children and are more likely to help them enroll for insurance,” said Gary Greenberg, a physician who runs the free clinic at Urban Ministries of Wake County. “Closing the health insurance gap will provide better economic security for more families and better economic security for the state as a whole.” (DHHS Officials Hear Critiques, Feedback on Proposed Medicaid Plan: North Carolina Health News)

Medicaid reform needs to include expansion: In September of 2015, House Bill 372, was passed by the General Assembly and moves the system from a fee-for-service model in which doctors are paid for each service they provide to a managed care system and is the result of more than three years of negotiations between the House, the Senate and Gov. Pat McCrory. It is expected that it will take another three to four years before any reform actions will be implemented. In the meantime, our state’s most vulnerable residents will continue to fall into the coverage gap, putting themselves and their families’ stability at risk.

Expanding Health Insurance in North Carolina would:

SAVE LIVES:  There are 1,000 people annually whose deaths are attributable to lack of health insurance.

CREATE JOBS: 1,500 jobs would be created in Buncombe County by 2020. Medicaid expansion by 2016 would translate into 43,314 jobs in North Carolina, including 23,000 jobs in health care.

SAVE MONEY: $318 million by 2020

INCREASE REVENUE: $862 million in North Carolina by 2020; $5 million in Buncombe County. North Carolina has already missed out on $6 billion in federal funding and some $100 million in potential sales tax revenue from not expanding Medicaid.

This information gathered from WNC Medicaid Expansion Advocacy group

How Will Expanded Medicaid Help Our Children?

From NC Child: The issue for children is that over 100,000 parents statewide are in the coverage gap, and when parents don’t have health insurance, the whole family is less healthy, both physically and financially.  The parents in the coverage gap have incomes too high to qualify for Medicaid and too low to purchase health insurance in the private market. Most of them are working, but they cannot afford to buy health insurance on the prevailing wages in industries such as retail, construction, or food service. 

Here are some specific reasons why closing the coverage gap is so important for North Carolina’s children:

•  When parents are insured, children are more likely to be insured. We know from the experience of other states that when parents get health insurance their children are more likely to be covered as well. In Massachusetts, for example, expanding health coverage for parents helped cut the uninsured rate for children in half. About 90,000 children in North Carolina, more than the total population of Asheville, remain uninsured even though they are eligible for one of North Carolina’s public health insurance programs, Medicaid or NC Health Choice. Offering whole family coverage will help bring down that number.

•  A plan for closing the health coverage gap is an important strategy to reduce infant mortality in North Carolina. Across the state, the infant mortality rate correlates with women’s health—a baby is much more likely to be born healthy if her mother is healthy. Statewide, 22 percent of infant deaths are related to prematurity and low birth weight, and 16 percent are related to maternal factors and complications of pregnancy. Access to care before conception and between pregnancies has the potential to substantially reduce our high infant mortality.

•  Insuring parents provides economic security to the whole family. Medical debt is a leading cause of bankruptcy. When one member of the family is uninsured, the entire family is at risk of financial ruin. It is only by covering the whole family that children are protected from this vulnerability.

What can I do?

We know that children are healthier if their families are healthy. So making sure parents have access to health insurance is critical for the health of our state’s children. And there’s the problem.

• Go to the NC Child Advocacy Toolkit  to look at letters to the samples of letters to the editor, sample petitions, FAQ’s and more! This toolkit will have everything you need to start a campaign for Medicaid expansion in your community.

•  NC Left Me Out has been launched to collect stories of people who fall into the health insurance gap: those who make too little money to qualify for subsidies on the Health Insurance Marketplace for private insurance but also do not qualify for Medicaid. By accepting federal funding, our state could insure 500,000 North Carolinians. NC thus far, however, has refused, and many of our hardest workers are those who are hardest hit. Employees in construction, hospitality, and sales are among those least likely to be insured as a result of N.C’s decision not to expand Medicaid. These workers need access to affordable healthcare in order to stay healthy, working, and financially secure.

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A Statement from Amanda Stem, Advocacy Supervisor from The Western North Carolina AIDS Project

The South East region has the highest rates of new HIV infections in the United States. As of March 2016, the South also includes 9 of 19 states not expanding Medicaid. Right now in North Carolina, people living with HIV and who are also uninsured must rely on The Ryan White Program which does not provide comprehensive or preventative health services. Expanding Medicaid in North Carolina would decrease the number of people living with HIV who fall out of care and get off medications by increasing access to transportation resources and providing more people, more options to a healthcare provider of their choice. In Western North Carolina, a primary barrier to care for people living with HIV is transportation. Many people living with HIV in Western North Carolina have to drive over two hours to visit their Ryan White HIV care provider. Medicaid Expansion would change that. Medicaid Expansion would provide insurance to 500,000 uninsured North Carolinians. That is 500,000 potential new HIV infections that could be prevented or detected early by providing individuals and families with comprehensive sex education and safe access to testing services because they were able to use a trusted healthcare provider of their choice. All North Carolinians deserve equal access to healthcare…and to a bathroom of their choice. The new North Carolina Medicaid plan is a restructure. This is not enough. To truly reform, would be to expand.



This story is part of a series collected by The Success Equation. Under the umbrella of Children First/CIS, the Success Equation is an initiative that unites community to reduce and prevent the root causes of poverty so all children can thrive. Get involved! Learn about action steps, volunteer opportunities, and help share these messages by going to To find more, go to