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Rural WNC fights for Medicaid expansion

Kathleen Wood attended a Medicaid expansion rally in Waynesville on the evening of June 28. Cory Vaillancourt photo Kathleen Wood attended a Medicaid expansion rally in Waynesville on the evening of June 28. Cory Vaillancourt photo

Only $80 stands between Sylva resident Carrie McBane and affordable health care coverage. If she made $80 less she would qualify for Medicaid in North Carolina, and if she made $80 more she would qualify for subsidies through the Affordable Care Act. 

The restaurant jobs she’s worked for the last 14 years have been too small to offer employees insurance and she can’t afford a private health care plan. Meanwhile, the medications she needs to control her type 2 diabetes are expensive but necessary to keep her healthy. McBane is not alone — she’s one of more than 500,000 people across the state that fell into the gap created when the state legislature originally chose not to expand Medicaid in 2014. 

“My story is typical of the more than half a million North Carolinians who fall into the health care gap. I worked for years as a restaurant server and made just a little too much or too little to get health coverage,” McBane said. “At the end of the day, a person’s ability to get medical care shouldn’t depend on how much money they make. Expanding Medicaid is a step in the right direction to guaranteeing health care for all people.”

Trevor Gates, a 24-year-old resident of Jackson County, said he wouldn’t have been able to accomplish all he has without the health care coverage he has received in the past. He is also legally blind and suffered from several life-threatening conditions as a child. While he is in remission, he said he lives in fear those safety nets could be stripped away, leaving him unable to fight illnesses or afford his many medications. 

“I graduated from Southwestern Community College with two associate’s degrees and I’m a Western Carolina [University] student majoring in psychology,” Gates said. “The only reason I’ve been able to chase my dreams is because I’ve had health care, but I live in constant fear of this rug being pulled out from under me. It would be less stressful if Medicaid expansion would be there to catch me if I need it.”

Waynesville resident Kathleen Wood, originally from New Jersey where Republican Gov. Chris Christie expanded Medicaid, was a social worker for almost 38 years. She showed up at the Medicaid expansion rally held at the Historic Haywood County Courthouse last Friday to show her support and tell her story. While she would never suggest the government should give people a permanent handout, she does know how critical it is for impoverished people to be given a hand up in their time of need. 

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“I grew up very, very poor, and have multiple disabilities. I’m legally blind. I’ve also got cerebral palsy. I was very fortunate that the New Jersey Commission for the Blind gave me a great deal of support and sponsored my education, but Social Security and Medicaid is what I survived on while I was going to school,” she said. “It’s so critical to give people the basic support that they need so they can move toward self-sufficiency.”

Wood said state legislators need to understand it’s extremely difficult for people to focus on their future and become productive citizens when they are constantly just trying to get through the day without worrying about where their next meal will come from or how they will pay for their insulin. If you’re just trying to survive, you’re not able to thrive, she said. 

“Get your head out of the clouds, come down here and meet some real people who are not the one-percenters and see how many people want to do better,” she said at the rally. “Give them the basic support so they can. You were hired to negotiate. The art of politics is negotiation. Do it. Make people’s lives better. That’s what you were hired to do, not just get re-elected time and time again.”

Wood is not alone in her frustrations with the North Carolina Legislature and its inability to expand Medicaid or reach some kind of compromise. Many were hopeful the lawmakers this year would pass a budget that included expanded Medicaid, but it was completely left out of the spending plan presented to Gov. Roy Cooper last week. Cooper vetoed the budget, claiming it didn’t prioritize the most important things — health care, education and the economy. 

“I am vetoing this budget because it prioritizes the wrong things. It values corporate tax breaks over classrooms, gimmicks over guaranteed school construction and political ideology over people,” Cooper said in a press release. “Our neighbors, our friends, our farmers, our childcare teachers, our small business owners, our brothers and sisters in the grips of opioid addiction — these are the people in the health care coverage gap. But 2,305 days ago, the legislature slammed the door on expanding Medicaid in North Carolina. Every day that count gets higher is a lost opportunity to help our state.”


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Rep. Joe Sam Queen, D-Waynesville, (left) supports the expansion of Medicaid in N.C. Cory Vaillancourt photo


Expansion support

The governor isn’t the only champion of Medicaid expansion. Many in the public education, economic development and medical sectors have shown their support because of the many benefits it will bring to the state. 

In addition to insuring another 500,000 people in the state, expansion would also create jobs, inject billions of dollars of new revenue into the state to spur the economy and increase state and county tax revenue. According to a new study released last week from the Cone Health Foundation, expansion is estimated to create 24,400 additional jobs in 2020 and climb to 37,200 in 2022.

About half of the projected job growth is expected to occur in six large counties across the state, including Buncombe, Durham, Forsyth, Guilford, Mecklenburg and Wake counties. As a neighbor of Buncombe, it could also be beneficial for Haywood County’s workforce.

The report states that Buncombe would gain 1,293 jobs by 2022, Haywood would gain 100, Jackson would gain 263, Macon would gain 62 and Swain would gain 32.

The Haywood County Chamber of Commerce listed expanded health care services in its latest 2019 State Legislative Priorities. Specifically, the Chamber prioritized increasing capacity and funding for behavioral health services; expanding and funding opioid/substance abuse prevention and treatment and expanding resources that address the shortage of allied health care professionals to ensure access to care. 

The North Carolina Association of Educators made Medicaid expansion one of its top legislative priorities in addition to pushing for increased pay and more resources for teachers. While Medicaid expansion may not seem like a public education issue, John deVille, a Macon County educator and NCAE member, recently told county commissioners that it was critical to public education when rural hospitals continue to discontinue services in communities. He said a lack of accessible and affordable health care also impacts students in the classroom — it’s difficult for students to focus on learning when they are worried about their parents’ or grandparents’ health. 

Lucretia Stargell, vice president of Harris Regional and Swain Community hospitals, said the hospitals in WNC are very much in favor of Medicaid expansion because it means more people will seek primary care services as opposed to emergency care services, which are much more costly for the patient and the hospital. 

“When an individual has a way to cover the cost of health care, he or she is more likely to seek it. Through access to a family doctor, illness can be approached from a preventive standpoint and chronic disease can be managed through minimizing acuity of symptoms or disease exacerbation,” Stargell said. “Constrained access to primary care can lead to utilization of the emergency department for episodic or catastrophic illness.”

According to a new report from the Cone Health Foundation, Medicaid expansion would lower hospitals’ uncompensated care burdens, improve their balance sheets and reduce the risk of rural hospital closures. Six rural hospitals in N.C. closed between 2014 and May 2019 and of the 76 rural hospitals that closed across the nation in that period, 83 percent were in states that did not expand Medicaid.

Stargell said about 20 percent of the population in the counties that Harris and Swain hospitals serve do not have a way to pay for health care. Those people often forego routine preventive care to address an illness or chronic disease and their condition can become unmanageable while their financial burden can become insurmountable. The hospitals do provide indigent care to those who can’t pay, but the cost makes it more challenging for rural hospitals to expand the services needed to care for an aging demographic. 

“Hospital operations benefit when people who live in our communities receive the care they need when they need it and where they need it,” she said. “We are the safety net hospitals for the region with $4.8 million in services to patients, regardless of their ability to pay.”

The rural hospitals are also major economic drivers in the region. Together Harris and Swain serve a population of about 160,000 people in Jackson, Swain, Macon and Graham counties and the surrounding area. Harris and Swain employ 924 people and paid $1.2 million in local and state taxes last year.

“Economic viability in our local communities is important so we can continue to serve patients with hundreds of thousands of encounters each year, and provide jobs to strengthen the financial stability of individuals and families,” Stargell said. “Medicaid expansion would create an opportunity to review how we can serve our communities to a greater degree with the highest level of customer service, compassion and efficiency in the care we provide.”

Increasing access to health care is also a top five legislative priority for the North Carolina Association of County Commissioners. According to its 2019-20 legislative goals, the association would like to “support continued state funding of Medicaid and support legislation and state funding to close the Medicaid coverage gap.”


Benefits of expansion

• In calendar year 2020, about 464,000 more people will gain Medicaid coverage. This will rise to about 634,000 people in 2022, then stabilize.

• New federal funding flowing into North Carolina will rise by $2.8 billion in 2019 and gradually climb to $4.7 billion by 2022 because the federal government would pay 90 percent of Medicaid costs for newly eligible adults. From 2020 to 2022, North Carolina will gain $11.7 billion more in federal funding.

• The injection of billions of dollars into North Carolina’s economy will spur business activity, which will in turn create more jobs. It’s estimated that 24,400 additional jobs would be created in 2020, climbing to 37,200 more jobs in 2022, compared to levels if Medicaid is not expanded.

• The Gross State Product (a measure of economic activity in North Carolina) would be increased by $1.9 billion in 2020 and $2.9 billion in 2022.

• The increased economic activity and employment would trigger increases in state and county tax revenues, totaling $500 million in state revenue from 2020 to 2022 and $100 million in county revenue over the three-year period. The additional revenues can help the state and the counties address other budgetary needs.

Source: The Economic and Employment Benefits of Expanding Medicaid in North Carolina — June 2019. To read the full report, visit

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