Rural North Carolina has taken many body blows — and this year has pummeled us with even more. In January, ECU Health announced it is closing five clinics, including its inpatient behavioral health unit.
Rural mothers and fathers, daughters and sons need health care just like everyone else. And yet, here we are, dangerously lacking in the kind of health care resources so many others take for granted.
Rural people work hard. By custom, we don’t ask for much. We care about each other and hurry to pitch in when a neighbor — or a stranger — needs help. So why do we find our critical health care infrastructure falling away?
The answer, according to ECU Health’s announcement, largely has to do with a “disproportionate number of uninsured or underinsured patients.”
The good news, dare I say, amid this ongoing crisis is that the N.C. General Assembly is currently discussing a remedy: Medicaid expansion.
Many rural North Carolinians clock in to jobs day after day, but they don’t receive health insurance from their employers. They fall into the “insurance coverage gap.” The gap swallows up people who earn too much to qualify for Medicaid, but too little to qualify for a subsidy on the health insurance marketplace.
Hundreds of thousands of working people fall below the federal poverty line, which is around $26,000 for a family of four.
Prior to the pandemic, approximately 400,000 North Carolinians lacked access to affordable health insurance. Now, The Kaiser Family Foundation estimates the number of North Carolinians who would benefit from closing the gap has grown to over 600,000.
Like all of us, people in the coverage gap get sick and need medical help. Sometimes urgently. And like all of us, they seek appropriate care. But without insurance, the often high bill is out of reach.
That puts a serious financial strain on hospitals and clinics, leading to closures. And that makes the challenge of health care even more acute here for everyone. As clinics and hospitals close, the access to health care further deteriorates. With the closures, travel times between rural health care centers in places like Greene and Martin counties will be even more taxing.
So far, 38 states have moved to close their gaps by expanding Medicaid, with the federal government paying 90 percent of the cost. North Carolina needs to join these states.
The leader of the NC Rural Center, Patrick Woodie, has said of Medicaid expansion: “There is no other single policy solution that the legislature can enact that will bring this level of funding to our local economies, stabilize our healthcare system, and benefit our rural economy.”
N.C. Senate President Pro Tem Phil Berger has pointed to an example of a single mom raising two kids, making around $25,000 a year, who’d now be counted as too wealthy to receive Medicaid assistance. “Life just beats her down,” Sen. Berger said. “And if there’s something we can do to keep that from happening, we ought to take that opportunity … we need coverage in North Carolina for the working poor.”
N.C. House Speaker Tim Moore has astutely pointed out that, “North Carolina taxpayers already send dollars to Washington to pay for expansion, and it’s time to bring that money home.”
Yes, for the sake of every person building their lives in rural North Carolina, let’s bring Medicaid expansion and good health home.
Frank Bradham of Farmville, a graduate of NC State and ECU, has spent his career in eastern North Carolina working in public health, home health and hospital administration.