The percentage of North Carolinians without health insurance dropped from 20.4 last year to 16.7 as of mid-2014, according to a new Gallup national survey.
The phone poll asking people whether they have health insurance is the latest attempt to gauge results of the Affordable Care Act, which provides financial aid to help people pay premiums, blocks companies from denying coverage to sick people and, in some states, expands eligibility for Medicaid.
The act, often dubbed Obamacare, met strong resistance in Republican-led North Carolina. State officials opted not to expand Medicaid eligibility or create a state insurance exchange.
Despite that, more than 357,000 N.C. residents signed up for subsidized coverage by the time open enrollment closed this spring, a number topped by only four other states. However, it is not yet known how many of them already had insurance and how many paid premiums for the coverage they chose.
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The Gallup survey, like other recent tracking studies, shows the biggest gains in getting people covered came from states that accepted federal money to expand Medicaid for low-income adults.
“If we had expanded Medicaid, North Carolina could have been a model state. There was an opportunity that we have missed out on,” said Jonathan Oberlander, a UNC Chapel Hill professor who studies health policy.
An additional 300,000 North Carolinians would have been eligible under the federal Medicaid expansion plan, Oberlander said. The uninsured, including large numbers of single men without children, are more likely to end up in emergency rooms for care, which is costly to hospitals and to taxpayers who subsidize that care, he said.
North Carolina’s 3.7 point drop in its uninsured rate is similar to what the survey found nationwide but significantly less than declines in states such as Arkansas (down 10.1 points), Kentucky (down 8.5 points) and Delaware (down 7.2 points) that expanded Medicaid eligibility and created state exchanges.
The downward trend, in North Carolina and across the country, is welcome but expected news, said Adam Linker, health policy analyst for the Raleigh-based N.C. Justice Center.
“This is a good indicator of the direction things are moving,” Linker said, adding that solid data may take a couple of years to compile.
“We did have a robust enrollment,” Linker said, but “most of the work of covering the uninsured, just because you’re talking about a lower-income population, comes through Medicaid.”
Gov. Pat McCrory said last month that he is “leaving the door open” to expanding Medicaid after problems with the existing system are fixed. However, the state legislature has taken no action to do so.