Editorial: N.C. fails on ACA, falls behind

Editorial: N.C. fails  on ACA, falls behind
August 27
00:00 2015

The percentage of people without health insurance nationally has dropped into single digits, in large part due to the Affordable Care Act. The same cannot be said for North Carolina, where leaders stubbornly refuse to help implement the act.

The number of uninsured fell to 29 million, or 9.2 percent of the population, in the first three months of 2015, according to the National Center for Health Statistics. That represents a decrease of 7 million people from the previous year.

Among working-age people (ages 18 to 64), the number uninsured decreased by about one-third, to 25.5 million, from 39.6 million in 2013. Among those under 18, the number fell to 3.4 million, from 4.8 million in 2013.

The new report is not broken down by states, but there’s no reason to believe North Carolina does not continue to have one of the nation’s highest percentages of uninsured. In 2014, more than 17 percent of North Carolinians under age 65 were uninsured. Only six states had higher percentages.

Part of the national improvement undoubtedly is due to economic conditions, with people being hired by firms that already were providing health insurance. But it would be absurd to think the ACA did not play a role. The number of uninsured has dropped by nearly 16 million since the law’s major provisions went into effect.

The improvement spans all age, income and ethnic classifications. The most significant gains were made by those with incomes under or just above the poverty level. There also was significant improvement among Hispanics, historically the group with the highest uninsured rate.

In North Carolina, however, the improvement has been marginal. The percentage of uninsured fell only 2.6 percentage points, from 19.9 to 17.3, between 2013 and 2014. The health center considers this to be “no significant change.”

That’s no surprise. Since Republicans gained complete control of state government in 2012, the state has turned its back on the ACA. First, North Carolina refused to set up a state insurance exchange, forcing the federal government to take over that role.

Even so, more than half a million people have obtained coverage through the federal exchange. Could that figure have been higher had the state devised its own exchange and marketed it aggressively? We’ll never know for sure, but we suspect the answer is “Yes.”

And then there’s Medicaid. Under the ACA, states were urged to increase the income limit for Medicaid from 100 percent to 133 percent of the federal poverty level, which is $32,915 for a family of four. The federal government pays all the additional cost at first, with the federal share eventually dropping to 90 percent.

North Carolina refused to go along. As a result, another half million people are without health insurance. The cost of caring for them is absorbed by health providers who recoup their costs by charging more to their other patients. In other words, if you’re insured you will wind up paying costs that should be paid by the federal government.

State leaders insist they cannot expand Medicaid until the state Medicaid system is fixed. Never mind that the system now is financially stable, or that says “the state already had an excellent Medicaid managed care program, Community Care of North Carolina.” Legislators continue to insist the system is not working.

The state Senate would turn management over in part to commercial managed-care companies. The House doesn’t like that idea. Neither house shows any interest in expansion.

That’s too bad. The Affordable Care Act is here to stay, and it is working. North Carolina should do its part, so its people will benefit.


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