To the Editor:

Thank you for your recent very informative article about the status of Medicaid expansion In North Carolina. I would like to make a case for Medicaid expansion.

As you stated, the Affordable Care Act provides for the expansion of Medicaid in states and pays 100 percent for the first three years, and, thereafter, gradually tapers down to 90 percent by 2020. At no time would a state have to pay more than 10 percent of Medicaid expenses for the new people covered. Since Medicaid in North Carolina only covers children, the elderly, disabled and some parents of children, the expansion would cover around 500,000 additional North Carolina citizens who now do not have affordable access to health care.

The goal of the Affordable Care Act is to provide health care coverage for as many people as possible. As does most legislation, it contains multiple sections, each one dependent on the others. The poorest people were to be covered by the Medicaid expansion, and those without insurance who made more than 100 percent of the federal poverty level ($11,490 for singles, $23,550 for a family of four) would receive subsidies to buy health insurance from private companies in the new health care marketplace. Since those making less than 100 percent of the federal poverty level were to have been covered by Medicaid, the law does not provide subsidies in the marketplace for them.

When the Supreme Court declared the Affordable Care Act constitutional, it made the Medicaid expansion portion optional for states. This created a coverage gap for those making less than 100 percent of the federal poverty level in states which did not expand Medicaid.

The losers in states that did not expand Medicaid are the people who would have been covered by Medicaid expansion (who pay with their lives), the hospitals, anyone paying for health care, job seekers, the state economy, and federal taxpayers.

A recent Harvard/CCNY study estimates that opting out of Medicaid expansion will cost between 455 and 1,145 lives each year in North Carolina. These are preventable deaths. Those who do not have health insurance and cannot pay for health care cannot afford preventative care, which would monitor and treat chronic diseases such as diabetes, high blood pressure, and heart disease. They are forced to emergency rooms when a crisis occurs.

The federal government has traditionally helped hospitals, required by federal law to treat all who come to the emergency room, with funds to mitigate emergency care for the indigent. The Affordable Care Act cut this funding because most of the indigent were supposed to be covered by Medicaid. The refusal to expand Medicaid is causing a crisis in hospitals. Rural hospitals in Georgia and Alabama have closed because of the refusal to expand Medicaid in those states.

Because of the uncompensated emergency care that hospitals must provide, hospitals must raise their rates. This causes everyone paying for health care and/or health insurance to pay more to cover the increased hospital rates. The American Academy of Actuaries estimates that premiums for private insurance will be at least 2 percent higher in states that do not expand Medicaid. If Medicaid had been expanded, the incidence of uncompensated serious emergencies, along with hospital rates, would decrease. Emergency care is much more expensive than preventative care. Control of blood sugar levels reduces the need for amputations in diabetics. Medication can reduce the incidence of heart attacks and strokes. Arkansas, a conservative state that did expand Medicaid, reports a decline in the number of emergency room visits and in the number of uninsured patients. 

The North Carolina Institute of Medicine estimated that the expansion of Medicaid in North Carolina would create 23,000 jobs over the next 10 years and add $5 million per day to the economy. An analysis by Regional Economic Models Inc. (REMI) estimated expansion would add $1.4 billion in annual GDP growth. Expansion would bring in $15 billion in federal funds to the state, flowing to health care providers and local economies. Medicaid expansion would pay for itself.

Funds to pay for Medicaid expansion come from the federal government. All those paying federal taxes are paying for Medicaid expansion in other states but not reaping any of the benefits in North Carolina.

Expanding Medicaid should be a no-brainer. I cannot think of one valid argument against it that would trump saving lives, hospitals and jobs. This makes me concerned about the brains of the North Carolina legislators who voted against Medicaid expansion.

In this election year, voters should know how the candidates stand on this issue. State Sen. Jim Davis, R-Franklin, voted against Medicaid expansion; his opponent, Jane Hipps, supports expansion. State Reps. Michele Presnell, R-Burnsville, and Roger West, R-Marble, voted against it. Rep. Presnell’s opponent, Dean Hicks, supports it. Rep. Joe Sam Queen, D-Waynesville, voted for Medicaid expansion, but his opponent would repeal the entire Affordable Care Act, subjecting citizens to being denied health insurance because of pre-existing conditions and taking away health insurance for the more than 350,000 in North Carolina who signed up for it in the marketplace.

Many conservative states have expanded Medicaid, including Arizona, Arkansas and Kentucky. Their politicians put the well-being of their citizens before knee-jerk ideology and dislike of our country’s president. In November, please consider the hearts and brains of our Western North Carolina candidates when you cast your votes.   

Carole Larivee   

Waynesville