Peg O’Connell
Chair
This week, we recognize Universal Health Coverage Day, which calls upon healthcare advocates, like Care4Carolina, to raise our voices urging our elected leaders to make investments in health and understand the importance of universal health coverage (UHC). The origins of Universal Health Coverage Day are rooted in December 2012, when the United Nations unanimously passed a historic resolution calling for all countries to “accelerate progress toward UHC as an essential priority for international development.’’ UHC is defined as access to quality essential health services without individuals suffering financial hardship.
The UN’s identification of UHC as one of 17 Sustainable Development Goals rightly frames access to affordable health care as a core economic determinant of any nation. As a public health advocate myself, I am accustomed to speaking about improving the accessibility and affordability of health care within and across a community as the right and just thing to do. However, Universal Health Coverage Day, with its recognition of health security as an economic pillar for any society, reminds us that it is an urgent economic issue as well.
While Universal Health Coverage Day is international, it also allows us to focus on the local – what we need to do here in North Carolina to advance the accessibility, affordability, quality (and ultimately sustainability) of our own health systems. That leads me to the actual topic of today’s article: the urgent business case for Medicaid Expansion in North Carolina.
North Carolina remains one of 12 states that has not closed the health insurance coverage gap, denying hundreds of thousands of working adults access to quality, affordable health care. These adults make too little to qualify for subsidies on the health insurance marketplace, but either do not meet certain criteria or make too much money to be eligible for North Carolina’s Medicaid program.
If North Carolina closed the coverage gap, it would greatly reduce the likelihood that these adults have substantial medical debt or have to file for bankruptcy because of those healthcare expenses. While closing the coverage gap may not eliminate the problem of medical bankruptcy, having health insurance has the potential to greatly reduce financial hardship. Moreover, access to health insurance produces a variety of other benefits, such as better physical and mental health and greater use of health care services. This is likely because having health insurance improves individuals’ ability to afford medical expenses, such as seeing a health care provider, seeking screening and prevention services, and being able to afford medication when needed.
The impact of high medical costs is particularly severe for low-income, uninsured individuals who become sick or injured. One study found that uninsured people who became hospitalized were more than twice as likely to file for bankruptcy. It is not a coincidence that, after the passage of the Affordable Care Act (and the expansion of Medicaid in participating states), the number of bankruptcies nationwide dropped by half.
However, the business case for Medicaid Expansion does not end with the direct impact of closing the coverage gap for individuals; we also have to consider the impact coverage has on the sustainability of the health system as a whole, particularly in rural communities. We have experienced our share of hospital closures here in North Carolina in recent years. As reported by The Mountaineer (using data from the Sheps Center for Health Services Research), North Carolina has the dubious honor of being the state with the third-highest number of rural hospital closures since 2005. A hospital closure’s impact on a community goes beyond health outcomes and expanded travel times. There is also an economic cost to the community that the hospital once served: the closure of a hospital in a rural community is associated with a reduction of that community’s overall economic wealth.
The bottom line is that providing UHC is a must if we want to protect the uninsured from financial hardship and ensure they don’t have to make the difficult choice to delay medical care. Even more importantly, access to health insurance can improve the health and well-being of all North Carolinians, and that makes good fiscal and physical sense.