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Medicaid Momentum: NC Business Leaders Call for Closing Coverage Gap and Another Hospital Passes Resolution of Support


As business leaders in the State of North Carolina, we know firsthand that a strong workforce is essential to North Carolina’s economy. We also know that employee health is a big contributor to the strength of our workforce.

Unfortunately, 13 percent of North Carolinians under 65 are uninsured. These are our neighbors – they are construction workers, retail employees, restaurant workers, veterans and farmers; they are the bedrock of our communities. Currently, a family of four with working parents cannot earn more than $9,000 to qualify for Medicaid. But they earn too little to qualify for federal subsidies to buy their own insurance. They fall into a coverage gap.

The good news is that we can follow the lead of 37 red and blue states and close the gap. Doing so would allow an estimated 500,000 North Carolinians to gain access to affordable health care.

The General Assembly wisely chose to wait when Medicaid expansion first became available to states. It was a good idea, but the timing wasn’t right for North Carolina. Now, we are ready. Our Medicaid program is strong and stable and has been under budget for five consecutive years. Spearheaded by the General Assembly, Medicaid is transitioning to managed care, which will lead to greater budget predictability.

We all benefit from expanding access to insurance, starting with lower health care costs. When faced with a medical condition, those without insurance often have little choice but to rely on the emergency room, which legally must treat them regardless of ability to pay. The cost of this care is passed on to consumers through higher insurance premiums and higher medical costs for those with insurance. That’s why premiums for people who buy their own health insurance are seven percent lower on average in states that have closed their coverage gap compared to those that haven’t.

Closing the coverage gap is particularly powerful for rural hospitals and communities in North Carolina. Rural hospitals are disproportionately affected when people don’t have health insurance. With smaller margins to operate, rural hospitals often struggle to compensate for patients who can’t afford to pay for their care. Forty percent of North Carolina’s rural hospitals are operating in the red, and five have closed since 2014. We need to close the coverage gap to help keep their doors open.

Expanding access to health insurance in North Carolina would provide 12,000 veterans who currently have no insurance access to affordable health care, serve as a critical tool to fight the opioid epidemic, and support children’s health.

Furthermore, expanding Medicaid now would create an estimated 43,000 jobs in North Carolina over the next five years. By comparison, after Michigan (a state similar in size to North Carolina) expanded Medicaid coverage, it created 39,000 new jobs. Many of these new jobs would go to North Carolina’s rural counties, and be outside of the health care sector, driven by increased economic activity in our communities (e.g., construction, retail, food services).

And here’s the clincher, closing the gap is fiscally responsible. It requires zero state dollars as the federal government pays 90 percent of the costs and the rest is paid by hospitals and health plans.

The introduction of HB 655 NC Health Care for Working Families shows there is energy on both sides of the aisle to close the coverage gap. Legislators on both sides need to come together and find a bipartisan way to increase access to health care in a way that makes sense for North Carolina.

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