The number of uninsured Charlotte residents could drop by 36 percent, or 63,000, by 2016 because of Affordable Care Act provisions that extend health insurance coverage to more Americans, according to a report released Thursday.
The report, sponsored by the Robert Wood Johnson Foundation, shows Charlotte’s decrease would be greater – an estimated 57 percent – if North Carolina had chosen to expand the state’s Medicaid program for low-income and disabled residents, as about half the states have done.
Charlotte’s projected decrease was the highest among seven cities in states that did not expand Medicaid, according to the analysis, done for the foundation by the Urban Institute.
Researchers estimated that expanding Medicaid in North Carolina would cover an additional 36,000 uninsured people in Charlotte alone. That would bring the total number of Charlotte residents gaining insurance to 99,000 by 2016.
Researchers reviewed figures for 14 large U.S. cities – seven in states that did not expand Medicaid and seven in states that did.
Among all states, North Carolina was fifth-highest in enrollment through the federal online marketplace, surpassing most expectations for the first year of enrollment, particularly in a Republican-controlled state that did not create its own insurance exchange.
“The state had such robust enrollment, it follows that North Carolina cities would have a big impact on the uninsured in comparison with other states,” said Adam Linker, a policy analyst with the North Carolina Justice Center. “We’ve seen polling suggesting that the Affordable Care Act, even absent Medicaid expansion, is reducing the uninsured population.”
Because the U.S. Supreme Court ruled that Medicaid expansion could not be mandated by the new federal law, each state had the option of whether to expand eligibility by offering free or reduced-cost coverage to people with moderate incomes who haven’t been previously eligible.
“The biggest decline is happening in places where the Medicaid program expanded. ... In this respect, North Carolina is missing an opportunity,” said Dr. John Lumpkin, senior vice president of the Robert Wood Johnson Foundation.
Matthew Buettgens, senior research associate with the Urban Institute, said the study found that, even without Medicaid expansion, federal premium subsidies in the marketplace have helped expand coverage to people who had been uninsured. That expanded coverage “will result in more health care dollars coming into Charlotte,” including spending for health care-related jobs.
Cities in states not expanding Medicaid will face other challenges in addition to continuing to provide treatment for the uninsured, Buettgens said. As part of the ACA, doctors and hospitals will face reductions in Medicare reimbursement and other federal payments. He said that could be a problem for urban safety-net providers, such as Carolinas HealthCare System, which attracts patients from a broad geographic region.