North Carolina Becomes 40th State to Expand Medicaid

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Bill to allow expansion comes after 10 years of advocacy, brings hope for remaining states that have yet to expand Medicaid

April 21, 2023 (ACP) — In a landmark victory for the American College of Physicians and its allies, the state of North Carolina approved the expansion of Medicaid as allowed by the Affordable Care Act, offering hope that remaining states without Medicaid expansion will take action.

Dr. Lacy Hobgood, the ACP chapter governor in North Carolina, said the approval is the result of more than 10 years of hard work in advocating for Medicaid expansion by staff of the North Carolina ACP chapter.

“I work in Eastern North Carolina and have personally taken care of many patients who made too much money working one or multiple part-time, low-paying jobs to be eligible for Medicaid and did not have health insurance from their employer,” Hobgood said. “I have taken care of farmers, commercial fishermen and ministers who were never able to have health insurance. This [Medicaid expansion] is a true lifeline for those people who work one or more low-wage jobs and have literally been working themselves so hard that they have developed chronic health conditions.”

Governor Roy Cooper signed a bill to expand Medicaid on March 27, making North Carolina the 40th state to do so. The expansion is expected to add 600,000 people to Medicaid in the state.

According to a statement from Governor Cooper's office, “In North Carolina, rural residents are 40 percent more likely to be uninsured and eligible for Medicaid expansion, and eleven rural hospitals have closed in North Carolina since 2005, with more at risk of closure due to a high rate of uninsured patients and uncompensated care. North Carolina, like other states, is currently dealing with an opioid and substance abuse crisis. About 40 percent of overdose patients in emergency departments are uninsured, making it harder for them to get the follow-up mental health care they need.”

As a recent report by KFF (formerly the Kaiser Family Foundation) noted, “Concerns about the viability of rural hospitals have been cited as one factor that could potentially motivate lawmakers to expand Medicaid in the … states that have not already done so.”

ACP is a strong advocate for Medicaid expansion. As ACP policy states, “In order to benefit from health care services, people need to be able to access them.”

Republicans dominate the state legislature in North Carolina, and they long resisted Medicaid expansion. But their opinions evolved, according to Hobgood. Now, the bill signed by the governor expands Medicaid — but only if a state budget passes.

“Last year, we passed a budget for the first time in a few years,” Hobgood explained. “The governor and the legislature couldn't agree on a budget for a few years. In fact, the governor had vetoed a budget proposed by the general assembly, so we were simply continuing the most recently approved budget from before.”

Hobgood said the credit for advocacy efforts should go to the staff of the North Carolina Medical Society, which manages the state ACP chapter's administrative and local lobbying efforts.

What can other ACP state chapters learn from the success in North Carolina? Hobgood likes to quote the late North Carolina State University basketball coach Jim Valvano: “Win and advance.”

“Take things one step at a time and get through each game with an eye on the future -- the big prize,” Hobgood said, adding that it is important to play and engage, even if you take losses. “I can't just reach out to legislators when I need them,” he said. “I need to build relationships in advance, so that when I need them, they already know who I am, rather than only showing up when I am asking for something.”

More Information

An online toolkit with information for advocating for Medicaid expansion in individual states is available on the ACP website.

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Back to the April 21, 2023 issue of ACP Advocate