From Adaora A. Adimora, MD, MPH, FACP, FIDSA, professor of Medicine at The University of North Carolina at Chapel Hill and vice chair of the HIV Medicine Association in Arlington, Va.:
As a physician who cares for uninsured patients, I see a North Carolina decision to participate in the federally supported Medicaid expansion as an easy one. It’s a chance to keep my patients and our state healthier. But the reasons go well beyond better health for my patients and our state’s working poor. Sadly, it is looking more certain that politics will trump good policy and hope for better access to health care for North Carolina’s 1.5 million uninsured residents.
We rank 38th in the nation in terms of health outcomes, including mortality rates and other measures, like how many adults have diabetes. We’re 12th highest in the number of people diagnosed with AIDS, a condition now preventable if patients are diagnosed early and have access to care and treatment available through programs like Medicaid.
Expanding Medicaid coverage to low-income adults trying to get by on less than $15,000 a year will mean greater access to lifesaving medical care for nearly half a million North Carolina residents who need it but cannot afford it today. The federal government will even pick up most of the tab, covering 100 percent of the cost of the expansion for the first three fiscal years, declining to 90 percent in future years.
The upside doesn’t end there. Over the next eight years, the state would see a net savings of $65 million from the Medicaid expansion, the North Carolina Institute of Medicine estimates. The expansion would help generate an additional $1.3 billion to $1.7 billion in the state’s gross domestic product each year, according to economic modeling commissioned by North Carolina’s Department of Health and Human Services.
As many as 25,000 new jobs would be created in the state by 2016 as a result of expanding Medicaid, the economic analysis also found. In a place still hard hit by the economic downturn, where the 9.2 unemployment rate statewide ranks third-highest in the country, it would be foolhardy to walk away from these potential job gains.
In my practice, I treat patients with infectious diseases, including those infected with HIV. I see firsthand the struggles many of them face because they cannot afford or do not qualify for health insurance. Too many don’t receive the care they need until they are seriously ill when treatment is less effective. Their lives are often needlessly shorter and hospital bills higher than if they had the regular access to care that Medicaid provides.
North Carolina has a historic opportunity to break this cycle and expand health coverage to my patients and many other fellow North Carolina residents without access to the basic health care that many of us take for granted. Twenty-four states, led by governors from both political parties, have signed up so far. It makes good fiscal sense, too, offering savings for the state’s tight budget, greater economic growth and new jobs statewide.
The math and the implications for the state’s health – physical and financial – are clear. We can afford to expand Medicaid in North Carolina. In fact, we can’t afford not to. The governor and the General Assembly should reconsider the data and reverse the unhealthy and costly decisions they are making for North Carolina.
These views do not necessarily reflect the opinions and views of the University of North Carolina at Chapel Hill.
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