Expanding Medicaid eligibility in North Carolina this year would result in about 150 more jobs and about 5,600 more people being eligible for this insurance coverage in Wilkes County in 2022, according to report released Wednesday.
The report was prepared by researchers at George Washington University in Washington, D.C., with funding from Cone Health Foundation and the Kate B. Reynolds Charitable Trust. The researchers updated a 2014 report, providing a county-by-county look at the number of jobs, new Medicaid enrollees and economic growth that would result from the state expanding Medicaid eligibility.
The study is based on the impact of expanding Medicaid eligibility to the income criteria of 138% of the poverty line for adults 19 to 64, which is $29,400 for a family of three, as allowed under the Affordable Care Act and as proposed by Gov. Roy Cooper. North Carolina is among 14 states yet to expand eligibility to this point.
Currently in North Carolina, parents with incomes up to 142% of the federal poverty level are eligible for Medicaid and adults without dependent children generally aren’t covered in the state.
According to the report, expanding Medicaid eligibility to the income criteria of 138% in 2019 would result in Wilkes County government gaining over $500,000 in property tax revenue from 2020 to 2022. It says 4,100 more Wilkes residents would be eligible for Medicaid starting next year.
The report said that statewide, expanding Medicaid now would result in about 37,000 additional jobs and over 600,000 more people being eligible for Medicaid across the state in 2022.
The George Washington University study says North Carolinians are already paying for Medicaid expansion in 36 other states without reaping the benefits of those federal tax dollars. The study says North Carolinians are about twice as likely to be uninsured as people neighboring states like West Virginia and Kentucky, both of which expanded Medicaid.
The report said slightly more than half of the job growth (20,600 jobs) statewide resulting from expanded eligibility would be in the health care field. The other 16,600 jobs created would be in other fields such as construction, retail sales, professional and management services, etc.
“Although Medicaid funds would first flow to health care providers, they would then ripple out into other parts of the economy as staff employed in health and other fields purchase food, pay their rent and mortgages, and make other consumer purchases,” the study said. “The economic growth would increase North Carolina’s tax base and ultimately increase both state and county tax revenues.”
North Carolina currently funds about 33 percent of the total cost of services for the state’s more than 1.7 million Medicaid enrollees. Wilkes County currently has 16,359 people enrolled I Medicaid.
If eligibility was expanded to 138 percent of the poverty level, the state would pay 10 percent of the cost of Medicaid and the federal government the remainder.
Medicaid is a federal health insurance program administered by the N.C. Department of Health and Human Services for people unable to afford insurance on their own.
A compromise budget endorsed by the state House and Senate this week includes no provision for Medicaid expansion. Cooper, who has been pushing for expansion, is expected to veto the budget and force a showdown with Republican legislative leaders. GOP leaders can’t override the veto without the votes of at least seven Democrats in the House of Representative and one Democrat in the Senate.
Senate Leader Phil Berger, a Republican, disputes reports saying expansion would boost the economy and provide health care to people in need and discouraged residents in a recent op-ed from joining the bandwagon. “A full accounting of the facts leads to the inescapable conclusion that expanding Medicaid would be a mistake that not only will fail to solve the problems its proponents claim it solves, but will create new problems and rekindle problems that have just recently been put to rest — such as Medicaid cost overruns and yearly budget deficits,” Berger stated in a press release.
Sen. Deanna Ballard, R-Watauga, whose district includes Wilkes, said the state’s Medicaid program already covers low-income parents, children, pregnant mothers, the elderly, blind and disabled. She said expanding eligibility to include able-bodied, single, childless adults “would prioritize funding and access over our most vulnerable citizens in the state.”
Ballard said supporters of Medicaid expansion claim it will provide insurance coverage for about 500,000 people without coverage, but she said the truth is that about 300,000 of those 500,000 are either eligible for government-subsidized health coverage through the federal exchange or are already receiving health insurance through an employer.
She noted that the compromise (between the House and Senate) budget released this week includes a provision that encourages the governor to call a special session in the fall to consider access to health care across North Carolina, including issues pertaining to health insurance, association health plans, Medicaid, and Medicaid expansion. “I hope the governor will sign the budget and bring us back to Raleigh later this year to focus on these critically important issues,” said Ballard.
Rep. Jeffrey Elmore, R-Wilkes, concurred with Ballard and also said now isn’t a good time to expand Medicaid eligibility because of North Carolina’s transition to prepaid health plans for people with Medicaid in 2020. Elmore said this shift to managed care needs to occur without additional complications.
Mark Hall, who directs the Health Law and Policy Program at the Wake Forest University School of Law, addressed this issue on an article by WRAL in Raleigh.
Hall said, “Funds for (Medicaid) expansion do not divert any current funding for disabled care. Instead, credible research shows that waiting lists for disabled enrollees have grown worse in non-expansion states like North Carolina than in expansion states. Also, in no sense does expansion put anyone “ahead of” people with disabilities. Instead, both groups would now be on par with regard to coverage for essential medical care.
Hall also said states that have expanded Medicaid eligibility haven’t faced major provider capacity problems, partly because expansion provides more funding to hire “physician extenders” such as nurse practitioners.
He said that while expansion wouldn’t solve physician shortages, it would help recruit more providers by substantially increasing funding for rural health care. Hall said it also would reduce the burden that rural physicians face of providing uncompensated care for low-income uninsured people. He said it would help keep rural hospitals open.