Sunday, March 1, 2015

Why We Must Fight For Medcaid Expansion

North Carolina’s continued rejection of Medicaid Expansion perpetuates systemic racism1. Even as we may work passionately to rid our own souls of every vestige of racism or classism, our failure to address systemic discrimination still sits on our shoulders. To that end, it is important that we call upon NC’s leaders to get off their duffs and pass Medicaid Expansion.

Medicaid Expansion is a critical component of the Affordable Care Act (ACA) and is intended to provide health insurance and improve health care access to millions of Americans who can neither afford to buy private insurance nor access coverage through their employer. Those millions of people make too much money to qualify for traditional Medicaid coverage but not enough to qualify for subsidized insurance. They fall into the insurance gap. That gap includes 357,000 North Carolinians: a number equivalent to filling every seat at the Charlotte gathering every Sunday for more than 33 years. That many people are being denied health insurance coverage in North Carolina. And, those people are disproportionately people of color.

One needs only to quickly peruse the 2010 report card on North Carolina’s racial and ethnic health disparities produced by the Department of Health and Human Services (Yes: the very government denying Medicaid Expansion has an office that studies and advocates overcoming major differences in health between whites and people of color!) to find statistical evidence that people of color have significantly poorer health outcomes than whites in North Carolina.2 Rejecting Medicaid Expansion results in preventing 357,000 people who are mostly people of color from accessing health coverage. That’s the same population of people who already experience worse health outcomes than most. See where this is going?

But it gets worse! Failure to expand Medicaid, has already cost North Carolina billions of dollars and thousands of jobs. A recent study examined the potential impact of this failure county by county in North Carolina on tax revenue, job creation, business activity and health insurance coverage. According to this study, if NC expands Medicaid in 2016, it will help create 43,000 new jobs and save the state budget $300 million by 2020.3

North Carolina has one of the largest wealth gaps in the nation, with only 17% of whites, compared to nearly ½ of all people of color, experiencing asset poverty (including things like home equity and pensions). Wealth of this kind can be used to generate more income and passes from generation to generation. So, this disparity is self-perpetuating. And, yet, as one of the poorest states in the nation and with almost ½ of our people of color living in asset poverty, we reject 43,000 new jobs and $300 million in state budget savings?

The ACA was passed by the U.S. Senate in December 2009 and the U.S. House of Representatives in March 2010, signed into law by President Obama March 23, 2010, and upheld by the U.S. Supreme Court June 28, 2012. In its ruling, the Supreme Court allowed states to individually choose to participate or reject Medicaid Expansion, the part of the ACA critical to providing health insurance to millions of low-income Americans. North Carolina, like many other Republican led Southern states, rejected it.

As of January 27, 2015, 28 states and the District of Columbia are expanding their Medicaid programs and embracing millions of people. Three states are considering expansion and 19 – including North Carolina – are still on record as neither expanding nor considering expansion. Earlier this month, NC Governor McCrory emerged from a White House meeting “breathlessly declaring”4 his surprise that the White House is willing to work with states on compromise plans to help these millions of people.  And yet, several states that originally rejected Medicaid Expansion have already negotiated waivers with the White House allowing those states to charge premiums or include co-pays to people newly covered by the expansion. Our Governor apparently didn’t know that.

As I said earlier, our failure to address systemic discrimination still sits on our shoulders. Join Reverend Robin and fellow PUUC congregants at the NAACP’s Mass Moral March on Raleigh February 14, 2015. Write your legislators. Do something. We cannot sit this one out.

January 31, 2015
A. Elaine Slaton

1 (government, institution, or system policies and practices that disadvantage people of color)

2  Office of Minority Health and Health Disparities and State Center for Health Statistics, NC DHHS. Racial and Ethnic Health Disparities in North Carolina: Report Card 2010. Retrieved from

3  Linker, Adam. New study shows that state lost billions of dollars and thousands of jobs by refusing Medicaid expansion; Legislators can still change the course. December 19, 2014. Retrieved from


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