Let’s take care of the 700,000 North Carolinians Medicaid expansion won’t help | Opinion

Imagine a North Carolina where everybody has access to high-quality medical care regardless of their ability to pay, a place where people don’t have to live in pain or let health issues become chronic, even life-threatening because they can’t afford to see a doctor.

The N.C. General Assembly brought us closer to that goal in March with passage of Medicaid expansion, a wonderful step that will save lives and improve health outcomes for 600,000 people who will become eligible for the federal health care insurance program.

But it’s just one step. According to the Kaiser Family Foundation, Medicaid expansion won’t cover some 700,000 North Carolinians who will remain uninsured and unable to afford even a basic level of primary care. These are our neighbors — many are essential workers we count on — who have fallen through the gaps of a system that leaves folks vulnerable if they don’t get health insurance coverage at work and earn too much to qualify for Medicaid.

April Cook

This sobering reality underscores the need to strengthen the safety net of health-care providers that serve uninsured and underinsured residents at little or no cost to the patient. As co-founder of a free and charitable clinic and now an advocate for 70 similar clinics across the state, I’m gratified to see growing awareness among public health and elected officials that our safety net still doesn’t protect all of our residents. We must do more.

Thankfully, our state lawmakers increased support for safety-net health care providers during the pandemic — and have included new funding in the proposed 2023-24 budget. They know expansion alone will not get us to the goal of access to basic care for all.

Health officials statewide are calling for more resources to serve the uninsured, including expanding the safety net comprising free and charitable clinics, public health departments, federally funded community health centers, and clinics run by large health systems.

In Mecklenburg County, these providers currently reach about 40% of the 124,000 people living without health insurance. While expansion will cover an estimated 64,000 of those uninsured, the safety net would need to expand dramatically to serve the 60,000 who will remain uninsured. In Wake County, the situation is similar, with about 119,000 residents uninsured.

Access to preventative primary care is critical to maintaining health, spotting disease early, managing chronic illnesses, and avoiding costly complications and hospitalizations that drive up health care costs for everyone in North Carolina.

Among the services safety-net providers offer, perhaps the most important is giving low-income residents a medical home where they receive care from a doctor who knows them, understands their history, and can prescribe a personalized treatment plan.

Without a safety net, the uninsured turn to the hospital emergency department when they get sick, clogging EDs meant for trauma cases. Or worse, they go without care until problems become acute and more expensive to treat, racking up unpayable medical debt that fuels escalating health care costs.

In 2021, free and charitable clinics saved N.C. hospitals an estimated $369 million in “uncompensated care” by giving 82,000 of our uninsured neighbors a medical home and providing 189,000 patient visits, $316 million in health care services and $181 million in prescriptions.

Failing to provide access to care has other potential costs, too. Most of North Carolina’s uninsured are the low-wage essential workers we rely on every day. In fact, more than 70% of the patients served by free and charitable clinics are employed. Keeping them healthy is essential to a thriving economy.

I’ll never forget the farmer who drove his tractor to my clinic because he needed medication and had no other way to get there. He is like most patients we serve, hard-working folks who bring us food and other goods and services we need. The least — and best — we can do is help take care of them, too.

April Cook is CEO of the North Carolina Association of Free and Charitable Clinics and co-founder of the Lake Norman Community Health Clinic in Huntersville.