How many people would Medicaid expansion in North Carolina truly cover?
It depends on who you ask.
Medicaid expansion has been the cause of a rift between Republicans and Democrats during the current state legislative session. Both sides agree that there should be affordable health care options for North Carolinians, but that’s where common ground mostly starts and ends.
Democratic Gov. Roy Cooper says Medicaid expansion will provide health care coverage for about 500,000 uninsured residents. These numbers are based on a report by the Cone Health Foundation.
But Republican Senate Leader Phil Berger said that number has been exaggerated.
“The truth is, approximately 300,000 of those 500,000 – 60 percent – are either eligible for government-subsidized health coverage through the federal exchange or are already receiving health insurance through their employer,” Berger wrote in a June op-ed in the News and Observer.
Under President Barack Obama’s Affordable Health Care Act, federal funds are available to cover more residents with Medicaid. North Carolina is one of 14 states that has opted not to participate in the expansion. If Cooper gets his way, the state will receive about $2.9 billion in additional federal Medicaid funding and state taxpayers would be on the hook for $173 million more.
The ACA rule raises income eligibility standards for Medicaid from 42 percent to 138 percent of the poverty level in North Carolina. Low-income pregnant women and children under 21 and their parents and most people with disabilities currently qualify for Medicaid. Expansion would mean anyone at any level of income up to 138 percent of the poverty level, regardless of dependents, would be eligible, according to Kelly Haight Connor, spokesperson for the North Carolina Department of Health and Human Services.
According to a report by the Kaiser Family Foundation, there were 417,000 uninsured adults in North Carolina in 2017. About 8 percent of the uninsured population was eligible for Medicaid while another 39 percent were eligible for the ACA Marketplace coverage.
In the middle were 215,000 adults who fell into the coverage gap. They make too much to qualify for Medicaid without the expansion, and too little to get ACA subsidies.
According to the ACA tool, subsidies are available only to people who make between 100 percent and 400 percent of the poverty level.
The national average unsubsidized premium for a 40-year-old non-smoker through the marketplace is $340 per month for the most basic plan. That does not include prescription costs.
Earlier this month, Cooper met with early childhood educators in Charlotte to discuss Medicaid expansion. The educators make less than $10 an hour and have a hard time affording health insurance, according to Cooper.
A 30-year-old with an annual income of $20,000 in Charlotte qualifies for an estimated $395 monthly subsidy and pays out-of-pocket $81 a month for the silver plan in the exchange, which falls in the middle. A 30-year-old that makes $40,000 annually qualifies for $148 monthly subsidy. The silver plan will cost them $425 monthly.
A 30-year-old without children who makes $11,000 annually would not qualify for subsidies and would pay $476 a month for the silver plan, which is more than 50 percent of their income. Under the current eligibity requirement, this adult will not qualify for Medicaid.
The debate over whether to expand Medicaid has stalled the 2020 fiscal year spending. Cooper vetoed the budget proposal that excluded the expansion. The House GOP has yet to hold a veto override vote since July 8.
Some Republicans have pitched another health care plan with income-based premiums and a work requirement.
The NC Health Care for Working Families program will cover North Carolinians between the ages of 16 and 64 whose income does not surpass 133 percent of the federal poverty level. The bill is currently in the House. It only becomes law if the Medicaid expansion does not.