After 43 years in business, I’ve learned a lot about developing ideas, creating plans and executing — which is why I and other business people are concerned about our state budget and its impact on Medicaid expansion.
Legislators did their due diligence by carefully studying expansion over several years, then made a wise choice in overwhelmingly voting earlier this year to make the move. But the approved legislation tied implementation to the passage of a state budget.
And tying implementation to the budget is the element of this otherwise excellent deal that is cause for concern. Because the state budget is late, and closing North Carolina’s health insurance ‘coverage gap’ cannot wait if we want to help so many of our fellow N.C. citizens.
The coverage gap refers to those who earn too much to qualify for Medicaid, but too little to qualify for a subsidy on the health insurance marketplace. This includes the many North Carolinians who report loyally to jobs day after day, but don’t receive health insurance from their employers.
Around 600,000 North Carolinians are in the coverage gap. A whopping 76% of those who would be eligible under an expanded Medicaid program are working yet still find themselves in financial straits.This is serious and drags on their ability to grow and thrive, and has long been an unnecessary drain on our state economy.
Thirty-nine states — red, blue and purple — have already discovered they would gain from closing the health insurance gap. If implemented here in N.C., all 100 counties would benefit. There would be an estimated growth of at least 37,000 new jobs in this state, mostly in medical and healthcare-related professions, and in fields with relatively high wages, including insurance, real estate and construction. There is no recruitment project that could yield this many jobs in as many places.
The N.C. Department of Health and Human Services is doing its best to tap the immense upside of closing the coverage gap while working with the legislature’s lagging budget negotiations.
It recently worked with the Centers for Medicare & Medicaid Services to announce an expansion start date of Oct. 1, 2023. This shortened the usual 90-120 day implementation period to 30 days — a major feat. And it is contingent on the General Assembly having a budget in place by Sept. 1.
Unfortunately, the political gears in Raleigh are turning even more slowly than many anticipated, and there is a sad chance that North Carolina will miss the Sept. 1 budget target.
Now, in effect, we’re in an execution gap. We have demonstrated the political will to expand Medicaid and reap the many rewards. Now we must use the execution muscles to get it done.
Delay is bad news for everyone. Yes, certainly for people in the coverage gap, but for all of us. Studies have shown people on private health insurance plans would see lower premiums — an 11 to 12% reduction in states that chose to close the gap. That frees private funds to get to work on the economy.
The aforementioned new jobs would spread across the state, including in struggling rural areas. Rural hospitals are most at risk of financial stress and closure due to lower rates of private health insurance and higher rates of uninsured. Over the past several years, rural hospital closures have been higher in states that have not expanded Medicare.
Clearly, Medicaid expansion is a good deal for North Carolina. Now it’s time to execute. And the N.C. General Assembly put itself squarely in the hot seat for that when it tied implementation to the state budget. As a former state legislator myself, I know budget negotiations can be complicated. I get it. But now is the time to close the coverage gap to help so many of our citizens.
Gene McLaurin is the president of Swink-Quality Oil Company and chair of the Economic Development Partnership of North Carolina. He is a former N.C. state senator (2013-2014) and former mayor of Rockingham (1997-2012).