RALEIGH, N.C. – North Carolina has taken a pass on almost $5 million a day in federal funds the state would be getting if it had expanded Medicaid.

In the coverage gap are 500,000 people who don't qualify for Medicaid, but can't afford insurance through the Marketplace.

But beyond the impact on individuals, the state's health systems also are missing out on some economic stability, according to a new report by the Georgetown University Center for Children and Families.

Nicole Dozier, director of the Health Access Coalition, says the economic impact is significant.

"Each year as a state, by not taking this money from the federal government, we're losing $2 billion,” she points out. “And that's more than what our state's budget is. So, it's shocking, it's disappointing."

Dozier says in recent years, the state has lost 3,400 health care related jobs and 4,700 other jobs connected to the industry.

The latest national Gallup poll on health coverage says 7 of the 10 states that have done the best jobs of getting more people insured have expanded their Medicaid programs.

Jack Hoadley, co-author of the Georgetown University report, says states that have expanded Medicaid have seen major reductions in the amount of uncompensated care delivered by safety net institutions, significant drops in the number of uninsured residents and budget savings for hospitals and community health centers.

"This is the kind of ripple effect,” he states. “It's not just the patient now comes in and gets a service, or now comes in and is able to pay for the service as opposed to receiving charity care, but the dollars that are saved – or the dollars that are brought in to these institutions – really are used in ways that really fundamentally change the way care is delivered."

So far, 31 states have chosen to expand Medicaid under the Affordable Care Act.

Dozier points out that the emerging economic disparity is already clear. She says the gap will only grow in future years as the expansion states continue to see greater economic benefit, and the holdouts are left out.

"North Carolina was thought to be a more progressive southern state and now, other states are passing us by,” she states. “There's less uncompensated care, the providers and the centers and hospitals are now having more financial security. They can look long-term with money and think about how they can improve their facilities."

The report also says health care facilities in Medicaid expansion states also see growth in new programs, such as expanding access to specialists – improving care for all patients, particularly in rural areas.





get more stories like this via email

New Mexico saw record enrollment numbers for the Affordable Care Act this year and is now setting its sights on lowering out-of-pocket costs - those not reimbursed by insurance. More than 56,000 New Mexicans are enrolled in a medical health insurance plan on the state exchange - an increase of 12,000 people overall.

Colin Baillio, deputy superintendent with the state's Office of Insurance, said the state has boosted its outreach and made efforts to improve the overall consumer experience.

"We saw a 40% year-over-year increase, and New Mexico saw the biggest percentage increase during the open-enrollment period among all of the state-based marketplaces," he explained

Part of the enrollment increase is due to what's called the "unwinding" - a federal directive that required all states to redetermine Medicaid eligibility following a three-year pause on checks during the COVID pandemic. He said by using expanded tools made available by the federal and state government, 8% of New Mexico's population is now uninsured - down from 23% in 2010.

Following approval by lawmakers in the 2024 legislative session, the New Mexico governor signed seven health care-related bills into law - one of which requires annual reporting of prescription drug pricing. Baililo said the Affordable Care Act built the foundation that has allowed the state to pursue additional affordability initiatives.

"I'm really glad to see that there's so much interest in the next step of health reform, really leaning into these out-of-pocket cost issues and making it easier for people to afford to stay covered and see their doctors," he continued.

Two years ago, the state also passed a one-of-a-kind law that did away with behavioral health co-pays for people in certain insurance plans.

New York's medical aid-in-dying bill is gaining further support. The Medical Society of the State of New York is supporting the bill. New York's bill allows terminally ill people with only six months to live to use this option, with safeguards requiring two physicians' approval.

The bill's Assembly sponsor Amy Paulin, D-Westchester, said despite the growing support, other hurdles lie ahead.

"Now we have what I believe, if it came to the floor, a majority. There's still a hesitation on the part of leadership. You know, we need members to assure leadership that they no longer have reservations," she said.

Other newly resolved concerns center on making sure insurance companies and doctors who don't support this aren't held liable. She's optimistic the bill will pass after nine years in the Legislature. New York would be the 11th state along with Washington, D.C. to have medical aid in dying legislation.

Corinne Carey, senior New York campaign director with Compassion and Choices finds the pandemic drew a vivid picture of a person's end-of-life experience. There were images of people dying on ventilators, apart from loved ones, and unable to communicate. She said people began thinking about a "good death."

"And, what is a good death is being surrounded by loved ones, having some measure of control, experiencing the touch of your loved ones, and being the one in the driver's seat," she explained.

Now people have different options for end-of-life care, each of which presents various challenges. Polls show medical aid in dying has garnered considerable support since being introduced in 2015. A 2022 Compassion and Choices poll finds 57% of nurses support medical aid in dying professionally, although fewer support it personally.

The California State Assembly is considering a bill to require schools to have a cardiac arrest response plan. Assembly Bill 2887 would make sure schools update their safety plans to include CPR training and an automatic external defibrillator or AED onsite.

Dr. Stephen Sanko, a professor of clinical emergency medicine at USC, and a founding member of the Cardiac Arrest Survivor Alliance, is a volunteer expert for the American Heart Association. He said having a plan in place is critical.

"The American Heart Association is promoting that schools have a cardiac arrest response plan. A written protocol for what to do in order to decrease the likelihood that if somebody collapses, that they die," he said.

Two years ago, 15-year-old Cash Hennessy collapsed on the football field due to a previously unknown heart defect. Two off-duty medics in the stands gave him CPR. The school brought out its AED - but it was useless, because the batteries were dead.

Hennessy said the experience was traumatic.

"I feel blessed that I had people there for me, that could give me C-P-R. But I think about if those people weren't there and that was another kid, who knows what would have happened? Because there wouldn't have been an AED to save them," he explained.

An AED walks people through the steps to deliver a life-saving shock to a person's heart until an ambulance arrives. Studies show that 70% of kids who suffer sudden cardiac arrest at school recover if an AED is deployed correctly - whereas the survival rate for kids and adults not in the hospital is less than 12%.