Every 11 minutes, an American dies because of a lack of health insurance. These are Americans that wouldn’t have died if they lived in France, Germany, Japan or Sweden—nations that really stand up for the protection of human life. These Americans include the out of work, but also those who work one or many jobs trying to make ends meet; in fact, around one in every four working-age adults is uninsured. These Americans were often those who had to decide between rent, food, medicine or electricity. These are Americans who work just as hard as we work, and who love just as much as we love.
For all the lives cut short for lack of insurance, there are many more lives derailed. Hospitals are required to provide emergency care regardless of an individual’s ability to pay, but they nevertheless bill the very poor for care received. For an uninsured individual, breaking a bone can mean breaking the bank. Uninsured patients routinely pay two-and-a-half times more for hospital services than those who are insured. For a family gradually eking its way into the middle class, a medical emergency can reverse its fortune, often leaving parents and children out on the streets. In fact, three-fifths of all bankruptcies are medically related. In simpler, smaller ways, a lack of insurance prevents poor children from being the best possible students and poor adults from being the best possible workers—whether its pain a toothache causes a child at school, or a strep throat your waitress might pass on to you because she can’t afford her antibiotics.
But wasn’t the Affordable Care Act (ACA) supposed to change all this?
There are many people now covered by insurance thanks to ACA: the Duke grad still looking for work a few months after graduation who can now stay on his or her parents’ health insurance until the age of 26, or the asthmatic entrepreneur whose “pre-existing condition” used to make finding insurance nearly impossible. The most important provisions of the ACA will kick in next year. More employers will be forced to offer their employees health insurance or face penalties. The insurance exchanges, in conjunction with the individual mandate, should make it much cheaper for the self-employed and unemployed to purchase insurance; in Massachusetts, the cost of the average individual, non-group premium decreased by 40 percent between 2006 and 2009, while across the country it increased by 14 percent. All of these provisions will make some difference. They will save some lives.
Among the provisions of the ACA, Medicaid expansion would have had the most dramatic effect. The ACA was more than paid for; the Congressional Budget Office projected that it would shrink, not raise the deficit. States would have expanded Medicaid up to 133 percent of the poverty line, chipping in just $1 for every nine federal dollars spent. This expansion was supposed to be more or less mandatory; however, the Supreme Court decided that states would have to opt-in to Medicaid expansion.
Bringing $9 into your state economy for every $1 spent is, plain and simple, a great deal. As an example, for every $1 spent by a film or TV company, the state of North Carolina gives the company a quarter back. In the case of Medicaid expansion, every dime spent would bring 90 cents to our state’s dentists, doctors and hospitals. Instead of making films, we’d be making the sick well. If you ask me, that’s a better use of state funds. The simple math of it explains why so many Republican governors have already signed on. Republican Gov. Jan Brewer of Arizona explained: “By agreeing to expand our Medicaid program … we will: … save and create thousands of jobs; and, provide health care to hundreds of thousands of low-income Arizonans. Saying ‘no’ to this plan would not save these federal dollars from being spent. … No, Arizona’s tax dollars would simply be passed to another state. … With this move, we will secure a federal revenue stream to cover the costs of the uninsured who already show up in our doctors’ offices and emergency rooms.” Duke University Health, along with more than 70 other groups, recently signed a letter urging Gov. McCrory to expand Medicaid.
North Carolina is one of just of a few states that hasn’t yet decided on Medicaid expansion—for just $138 million per year, we could provide health insurance to more than 700,000 of our neighbors. Though the state must make tough choices, the amount spent would be paid for more than four times over by restoring the 0.75 percent sales tax that elapsed in 2011.
I’m reminded of my home state’s toast: “Where the weak grow strong and the strong grow great, here’s to down home, the Old North State!” That is my vision for North Carolina—a vision I hope Gov. Pat McCrory and the General Assembly will come to share.
Elena Botella is a Trinity senior. Her column runs every Thursday. You can follow Elena on Twitter @elenabotella.