Poverty and no Medicaid expansion are taking a toll on NC’s health

The Kaiser Family Foundation, a nonprofit organization based in San Francisco, just issued a state-by-state report called “Snapshots of health care in the U.S.”

North Carolina wasn’t quite ready for its close up. In a range of categories, North Carolina — the nation’s 10th largest state with a population just over 10 million — is faring worse than the national average.

That picture contrasts sharply with the image of North Carolina portrayed by Republican leaders in the General Assembly. They claim that their tax cuts favoring the wealthy and big corporations and nearly a decade of tight limits on state spending have created a booming state economy that presumably enhances the well-being of the state’s people.

In fact, the state is still struggling with poverty despite a strong national economic recovery. The KFF report notes that 33.5% of North Carolina residents had incomes below 200% of the Federal Poverty Level in 2018, which was larger than the U.S. share (30.4%). And with more poverty comes more health problems. Indeed, in terms of its national health ranking, North Carolina has slipped from 31st in 2015 to 36th in 2019. In specific categories, the KFF report shows North Carolina exceeding the national average in adult obesity, heart disease, HIV diagnosis, infant mortality, the death rate due to firearms and the opioid overdose death rate.

These health problems and others are made worse by a lack of access to health care. Nearly 13% of non-elderly North Carolinians have no health insurance, compared to 10.4% nationally. That’s a million people who must pay for health care on their own, or go without. Many do the latter. The report found that “15.1% of residents ages 18 and older did not see a doctor when needed during the previous year because of costs in 2018, higher than the U.S. percentage (12.9%).”

North Carolina’s uninsured numbers would be worse had it not been for the Affordable Care Act, a law that the state’s legislative leaders resisted at every turn. Nonetheless, 447,680 North Carolinians were enrolled in ACA plans in 2019, with 94 percent of them receiving a tax credit to help them pay their premiums. If North Carolina had expanded Medicaid in 2018, the report estimates that 357,000 uninsured adults would have been eligible for the state and federal health insurance program.

To create a healthier North Carolina, expanding Medicaid is the biggest and perhaps the simplest step. But the state must also do more to reduce the causes of poverty and close the racial gaps in health conditions. That means increasing the minimum wage and the number of small businesses that offer health insurance benefits. Among North Carolina private businesses with fewer than 50 employees, only 19 percent offer health insurance, compared to 29 percent nationally, the KFF report said.

The state should also require employers to offer paid leave to workers when new children are born or adopted, or when serious personal or family health issues arise. Currently, only 12 percent of North Carolina’s workers have that benefit. Creating more parks for exercise and better access to healthy foods would also help.

Every 10 years, the state announces its health goals for the decade ahead. This year the state’s “Healthy North Carolina 2030” report called for action beyond wider access to health care. The report says, “Long-term sustainable improvements in the health and well-being of North Carolinians will only occur by addressing the social, economic, and place-based challenges that keep people from achieving optimal health.”

Tax cuts and holding out on Medicaid expansion won’t do that.

This story was originally published February 23, 2020 at 8:00 AM with the headline "Poverty and no Medicaid expansion are taking a toll on NC’s health."