Record unemployment is increasing pressure to expand access to quality, affordable healthcare, but North Carolina remains one of only 12 states to resist expansion of Medicaid under the Affordable Care Act. Pre-pandemic, without Medicaid expansion, close to 650,000 in the state remained uninsured. Today the number of people who fall into the Medicaid “coverage gap” – a group whose income is above eligibility for Medicaid but too low to qualify for healthcare tax credits – is likely much higher.
NC-09 is a district that truly encompasses the urban-rural divide. Mecklenburg county is the second-most populous county in NC and its most expensive county to live in; the median household income was $64,312 in 2018, about $3,000 more than the national average and $12,000 more in-state. Robeson is a rural area composed of coastal plains and sandhills– it is also the poorest county, with a median household income of $32,407 in 2017 and a 29.2% poverty rate, more than triple the national average and double in-state. These county discrepancies reveal how affordable healthcare would be crucial towards fostering equality across the district.
Since 2005, there have been 173 rural hospital closures in the United States, according to UNC researchers. 11 total in North Carolina, and 8 since 2010. COVID-19 has put increased stress on hospitals all over the world, but for NC-09 there has been irrevocable damage to rural community hospitals. Serving as both care and employment hubs, rural hospitals are vital fixtures in their communities and often people’s only choice for emergency healthcare. Shutdown orders caused these hospitals to lose millions, likely condemning some to permanent closure. Patients suffer the most, having to drive long distances to their next closest hospital or forgo medical care at all. A possible way of avoiding more rural hospital closures would be expanding Medicaid eligibility under the Affordable Care Act. The added revenue from expansion would significantly lessen the impact of this pandemic on rural communities by allowing funding to recruit physicians, make infrastructure improvements, but most importantly, prevent these hospitals from being at-risk of closure. To reap the benefits of doctors and development, hospitals must stay open.
Republican incumbent Dan Bishop opposes expanding health insurance coverage. Electing Democratic nominee Cynthia Wallace is the only route to making sure all North Carolinians have quality, affordable healthcare. Wallace has already stated that her first priority in Congress will be to healthcare access for rural counties. “Since Medicaid expansion has not occurred here in North Carolina, access to healthcare has been a challenge for all parts of the state but especially in rural areas,” said Wallace.
On the Republican side, Trump wants to overturn the entire Affordable Care Act and force the 12.5 million people who rely on the act to lose their insurance. Bishop, who is a Trump loyalist, has previously stated that he wants to repeal the Affordable Care Act and allow uninsured people to find coverage in the competitive market. In the current competitive market, the rate of uninsured people in North Carolina is 12.7%. In the three most rural counties of NC-09, this rate is higher– Scotland County 14.5%, Hoke County 15%, and Robeson County has 18.5% uninsured individuals. Wallace recognizes the need for aid among these populations, whose rural hospitals have been hit hardest during the pandemic.
Hospitals contain and sustain the entire lifecycle of humanity. In rural communities, this is especially true. Lack of affordable care negatively impacts both the institutions and their patients—something turned even more deadly in a pandemic situation. NC-09 must act now to increase insurance coverage and put an end to rural hospital closures.
Written by Left of Center North Carolina Specialist Sofia Noorouzi