The Transylvania Times -


By Eric Crews
Staff Writer 

Medicaid Changes Will Leave Some Locals Uninsured - Brevard NC


North Carolina legislators’ decision to “opt out” of the federally funded Medicaid expansion will leave a significant portion of Transylvania County residents uninsured, according to Adam Linker, a policy analyst at the N.C. Justice Center, a consumer advocacy group.

Linker was speaking to roughly 75 people at the Transylvania County Library last month. The state’s decision to opt out of the Medicaid expansion was approved in February as part of Senate Bill 4, a bill co-sponsored by N.C. Sen. Tom Apodaca, who represents Transylvania County.

Medicaid is the federal health program for families and individuals with low incomes.

One component of the Affordable Care Act, or Obamacare, as it’s also known, is that people must maintain health insurance or face a fine. That component was challenged in the U.S. Supreme Court, which found the act and the requirement to buy insurance constitutional.

But another component of the court’s ruling, Linker said, was that the new insurance requirements changed the Medicaid program substantially enough that it was essentially a new program. As such, each state had to agree to re-enter into the Medicaid agreement.

The Republican-dominated N.C. legislators declined, opting to turn down a $74 million grant to expand Medicaid and keep the existing program in place.

The federal grant would have paid for 100 percent of the Medicaid expansion costs for three years and then paid 90 percent after that.

Linker said that expansion would have led to substantial increases in the number of people covered by some form of insurance across the state, which, he said, would lead to lower costs for hospitals and other medical service providers.

Without it, millions in North Carolina will continue to fall between the cracks and go without insurance or Medicaid coverage at all, which leads to higher costs for all when hospital bills and visits to other medical providers go unpaid, Linker said. Currently, 1.7 million North Carolinians are uninsured, 19,000 of whom are in Transylvania and Henderson counties.

“Currently in North Carolina, Medicaid does not cover all low-income people,” Linker said, explaining that it covers “categories of people.”

“If you are a pregnant woman, you qualify for Medicaid at one level,” he said. “Once you have a child, you qualify at a different level. If you are an able-bodied adult who maybe just lost their job, you don’t qualify for Medicaid unless you have kids.”

To address those shortcomings, the Affordable Care Act would have provided Medicaid to everyone making less than 138 percent of the federal poverty level, which is roughly $15,000.

People making more than 138 percent of the federal poverty level would receive subsidies by paying insurance providers a portion of the total cost of coverage based on income levels. North Carolina hospitals, Linker said, are preparing for a double hit because of a combination of Affordable Care Act reforms and the lack of an increased number of paying clients.

“There were a lot of changes and a lot of reductions in hospital payments at the federal level, with the understanding that Medicaid would be expanded and there would be a lot of new paying patients at the hospitals,” he said.

Rising Medicaid Costs

The decision to opt out of expansion came as costs for North Carolina’s existing Medicaid program have soared, according to a February press release by N.C. Sen. Philip Berger, a Republican and president pro tempore.

In 2012, the General Assembly was forced to fill a surprise Medicaid shortfall that totaled more than $500 million, the release said. Recent figures from the N.C. Department of Health and Human Services indicate that an expansion of the program would add hundreds of millions of dollars in additional state costs to North Carolina’s Medicaid budget through 2019.

“Senate Republicans are committed to ensuring every North Carolinian receives the highest quality health care and outcomes,” Berger said in the press release. “Saddling our citizens with the enormous costs of a new federal bureaucracy and entitlements is simply not the way to achieve this goal.”

Insurance Exchange

In addition to opting out of Medicaid expansion, N.C. Senate Bill 4 also directed the N.C. Department of Insurance to return to the federal government unspent taxpayer funds awarded by the U.S. Department of Health and Human Services to create a state-federal partnership exchange.

Now, instead of a partnership, North Carolina residents will have access to only the federally managed exchange called the marketplace, which will be available to the general public beginning Oct. 1.

Linker explained how the new insurance exchange would work.

“Basically, the health insurance exchange is this new online marketplace where you will go and be able to compare plans and see what is available in your area,” he said. “Through that system, you’ll be able to see what subsidies you might qualify for and what plans are available.”

While the federal insurance exchange should be a notable improvement in shopping for insurance, Linker said he believes, based on his research of other states that have implemented the partnership, that costs would have been lower and competition greater if the partnership had been implemented.

“In this state we’ve decided not to set up an exchange,” he said. “What this means for the consumer is complicated.

“For the most part, the experience won’t seem that much different.”

Unlike Medicaid expansion, which would have provided new benefits to a wider range of the population, the health insurance exchange is fairly similar whether done through the federal level or the state level.

“What concerns me more about the state versus federal exchange is that the state did have a $74 million grant to begin setting up an exchange to at least leave the option open for a state-based exchange,” he said.

One aspect he liked about the state-based exchange is that it would have created a state call center that would have allowed residents to call a North Carolina help line.

Now North Carolina residents will have to call a Washington, D.C.,-based call center for assistance.

The grant would have also provided funding to hire around 200 people across the state that would have worked to help people navigate the new process.

While the $74 million grant that was rejected by N.C. legislators would have provided $24 million in funding for in-person assistance, other grants totaling about $6 million are being provided by the federal government to help hire a smaller number of individuals.

“It’s just a big difference in terms of how many people we can help,” he said. “And there will be a lot of people with questions.”

Open enrollment in the health insurance exchange can be done at

“This first year’s open-enrollment period will be six months,” Linker said. “There’s some time to get to know the system, get some help and figure out if this is even for you.”