Writer: Liz Palmer
3 min read November 2022 — Many healthcare leaders believe the expansion of Medicaid remains a part of the long-term answer for both bringing costs down and ensuring a healthier population, despite North Carolina remaining one of the few U.S. states yet to pass related legislation.
“Expansion is important,” Donald Gintzig, president and CEO of WakeMed Health & Hospitals, told Invest:. “In the long run, it’s about having the right resources to do it and making sure people are able to get access near where they live. A significant portion of those without insurance right now are among those who are in the most need. Medicaid expansion in North Carolina will help about 600,000 people get some type of coverage that hopefully will get them on a path toward a healthier life,” Gintzig said.
The long-anticipated Medicaid expansion in North Carolina was again pushed back again by the state legislature last week, meaning the two-year session will close out with North Carolina remaining one of 12 states still on the sidelines. Both the state Democratic and Republican parties have been working toward pushing the legislation through for years and got close this year but have disagreed on details, such as “certificate of needs” (CON) laws that Republicans want reformed and Democrats hesitate to address. North Carolina is a CON law state, meaning the Department of Health and Human Services must approve providers’ requests prior to any “acquiring, replacing, or adding to their facilities and equipment, except in specified circumstances,” as well as medical services, according to the DHHS website. Republicans are concerned about increased costs accumulated as a result of CONs that could bar access to care and support reform in conjunction with Medicaid expansion, while Democrats want it passed separately and to address CON reform in a way that would not impact hospital revenue, specifically smaller community providers.
When lawmakers announced the official pause toward expansion last week, Gov. Roy Cooper (D) tweeted the delay costs the state $521 million each month and is “astonishingly wasteful, irresponsible and cruel.”
The state’s healthcare sector has been closely watching discussions and weighing in on the best way to go about expansion. As healthcare gets more expensive, Gintzig believes something has to give. “Clearly, the more people who have access to some type of insurance coverage results in better long-term health. I have not heard anyone say that healthcare just doesn’t cost enough. Yet, everything associated with healthcare, in general, costs more. Supplies, drugs – they all cost a lot more,” he said. “The way we will meet our mission in the long run will be to help people be healthier. A healthier person costs less than a sick person. Illness, injury and disease won’t go away, but through access to some type of insurance – especially one designed for population health and early detection – we are able to catch and prevent long-term issues. The best way to do that is to work on prevention through some type of healthcare insurance model.”
Medicaid is one piece of that preventative model. Healthcare players are specifically interested in how expanding Medicaid would affect rural North Carolinians, as a recent report showed health coverage rates at 62% in rural communities, whereas urban communities see 68%. Public health insurance coverage is higher in rural areas at 42% than urban areas at 33%.
President and CEO of the North Carolina Healthcare Association Steve Lawler told Invest: his personal experience running a small, rural hospital in the state earlier in his career opened his eyes to their needs. Today, a key focus of the association is on ensuring rural hospitals have access to the resources needed to provide quality care to their communities through avenues like workforce development and policy advocacy. “We’re also focused on expanding Medicaid coverage, which would be huge for many North Carolinians. Over 600,000 people could be covered under the expansion, and small community hospitals could really benefit from more federal assistance,” Lawler said. “We want to get this legislation through. Having the people our hospitals care for have access to coverage means patients can access the system at the right time and in the right place. People without insurance typically wait to get care until they need a lot more help and resources. Expanding coverage access would help reduce this burden and encourage more preventative care measures.”
North Carolina’s General Assembly is now expected to revisit Medicaid expansion in its 2023 legislative session.
