Lack of health coverage hobbles young adults in NC, advocates say

Young adults make up almost half the low-income North Carolinians who don’t qualify for Medicaid or health insurance subsidies, advocates said in a report released Friday.

About 258,000 18- to 34-year-olds fall into the coverage gap, said leaders of Young Invincibles and the N.C. Justice Center, advocacy groups that want state leaders to expand Medicaid coverage to healthy, childless adults living in poverty.

Many of them are taking college classes and/or working in low-wage jobs. When they’re struck by illness or injury, they can end up with medical debt that hobbles their efforts to finish school and start a career, said Christina Postolowski, health policy manager for Young Invincibles, a national group focused on health reform and young adults.

Part of the challenge is convincing young, healthy people they need health insurance and a doctor to provide preventive care. But growing numbers are hearing about the Affordable Care Act, which mandates coverage and offers subsidies to help low- and moderate-income people buy insurance, said Adam Linker, health policy analyst for the Raleigh-based Justice Center.

Some are shocked to learn that “there’s nothing for them,” Linker said.

Democratic leaders who crafted the ACA thought states would use federal money to expand Medicaid to their most impoverished adults. But 23 Republican-led states, including North and South Carolina, declined to do so, with leaders citing worries about eventual state costs and doubts about the value of the expansion.

N.C. Gov. Pat McCrory recently met with President Barack Obama to discuss a waiver of federal rules that would let the state create its own plan for expanding Medicaid. But Senate President Pro Tem Phil Berger and newly elected House Speaker Tim Moore say they remain skeptical.

“There is in my view no good case that can be made that Medicaid expansion is the right thing for us to do in North Carolina,” Berger said when the 2015 session opened this week.

Linker said it’s too early to give up on expansion. Other Republican-led states have come up with expansion plans, he said, and “there’s resistance right up until they file a waiver.”