Six months in, Affordable Care Act seems to be working



Now that we’ve officially reached the half-year mark since the implementation of the Affordable Care Act, you might be wondering whether it’s been effective. In short — though there are still many “what ifs” and “maybes” — the law appears to be doing much of what it was intended to do: to allow more Americans to gain access to affordable health insurance plans, and, as such, to lower the number of people who have been going without it.

A nationwide Gallop survey shows that in North Carolina, the percentage of people without health insurance dropped from about 20 percent last year to about 17 percent as of mid-2014. The results were drawn from a phone poll in which people were asked whether they have health insurance. It’s important to note that the poll did not measure how many of those who say they now have insurance as a result of the ACA had coverage previously, or how many of those who signed up at the end of the enrollment period this spring have actually paid for their premium.

Still, more than 357,000 North Carolinians did sign up for coverage, a total surpassed by only four other states. Many more could have received coverage of some sort had North Carolina expanded Medicaid through the Affordable Care Act. But us and 23 other states run by Republicans refused. The debate over that decision is raging here, fueled by studies that say we are foolishly turning our backs on tens of billions of dollars in potential sources of revenue — while those who oppose expanding Medicaid at the state level say they’ll end up holding a fiscally unfeasible bag for years to come.

Here’s a few of the numbers, according to studies from sources including the nonpartisan Robert Wood Johnson Foundation and the Urban Institute:

- If North Carolina does not expand Medicaid, it will lose nearly $40 billion in federal funding over the next 10 years. Hospitals here will lose $11.3 billion in federal funding over that same time, money intended to offset their loss of funding for Medicaid and Medicare reimbursement. And the state will lose an estimated $307 million annually that would have come from economic growth caused by the expansion of Medicaid. The North Carolina Hospital Association, for example, estimates the state’s 109 acute-care facilities have laid off at least 2,000 employees as a result of the decision not to expand Medicaid, according to the Associated Press, which reports that expanding Medicaid would actually create an estimated 20,000 jobs statewide.

- By not expanding Medicaid, an estimated 300,000 to 400,000 residents of the state will continue to go without health care coverage of any kind, meaning they will have no choice but to go to emergency rooms for assistance, which is the most expensive means of delivering care and is a cost eventually passed along to taxpayers.

Meanwhile, the General Assembly continues to wrangle over the state budget with a shortfall that many, including Gov. McCrory, have said is largely the fault of the current Medicaid system, which the legislature has so far failed to agree on a restructuring, let alone any possible expansion per the ACA. McCrory has said recently that he is not opposed, in principle, to expanding the state’s system but that it must not “bankrupt” the state.

And so, even while some fellow North Carolinians apparently now have coverage they didn’t have at the beginning of the year, at least the same amount remain out in the cold.

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