Investing in Equitable Access to Care

There’s much to be done to achieve Mrs. Reynolds’ goal of improving the quality of life and health of residents throughout North Carolina. In a state that today has more than one million uninsured residents—10.7 percent of the population—one of the most impactful ways we continue our founder’s vision is by making sure people have equitable access to health care.

Several studies by the National Institute of Medicine conclude that a lack of insurance is hazardous to individual and community health. Luckily, programs already exist that provide more equitable health care access, such as Medicaid and the Affordable Care Act. To narrow disparities, we need to make sure people can receive the full benefits of these programs.

That’s why this year, the Trust has committed to fulfilling Mrs. Reynolds’ vision by investing more than $3 million in improving health care coverage for North Carolina’s families and children. We have supported an in-depth, county-by-county analysis of the economic and health benefits of expanding Medicaid; innovative insurance enrollment programs across the state; and cross-platform communications campaigns to broadly share information about what will happen if the state accepts or declines Medicaid expansion.

The history of medical insurance in North Carolina

The Patient Protection and Affordable Care Act (ACA) was signed into law in 2010, increasing insurance coverage by expanding insurance options for low-income individuals and by authorizing states to expand Medicaid eligibility.

Since the ACA was signed into law, it has led to historic gains in health insurance coverage. However, shifting regulations and a reduced federal advertising budget have understandably led to public confusion—it has become increasingly important for advocates to play a role in making sure underserved residents have the information they need to take advantage of the ACA’s health care opportunities.

While the ACA made health care more accessible in North Carolina, many of our state’s children and families are not able to benefit from it because North Carolina did not accept the federal government’s funding to expand Medicaid. This has left too many North Carolinians uninsured, making it hard for them to get the care they need to stay healthy.

This is a critical time for Medicaid expansion discussions in the state. North Carolina has an opportunity to pass Medicaid expansion this year, giving health insurance access to nearly 365,000 financially disadvantaged residents in the process.

North Carolina’s communities seek equitable access to care

At the Trust, we are committed to listening to and learning from the communities we serve. We know that community members are the experts on what they need to live happy, healthy lives—and the communities we work with have told us that they need Medicaid expansion. Uninsured adults and children obtain fewer preventive services, have more avoidable hospitalizations, have worse health outcomes, and, in some cases, are more likely to die from serious acute conditions than their insured peers.

The Trust’s 2019 grantmaking strategy was guided by this need for more equitable access to care statewide. It was important to us to fund organizations working to:

  • Close the state’s Medicaid coverage gap through education and by engaging community voices.
  • Increase the overall ACA enrollment of low-income individuals.

Our three-pronged, outcomes-driven investment approach includes:

1. Scaling and sustaining a promising and proven program

What we know: For the past five years, the Trust has helped to boost the ACA’s impact in North Carolina by investing in the capacity of nonprofits providing in-person enrollment assistance efforts, especially those targeting vulnerable and underserved populations. The collective public and private ACA enrollment efforts have proved successful in North Carolina, helping reduce the uninsured rate from about 21 percent in 2010 to a little more than 10 percent in 2017.

What we’re doing: In 2019, we are proud to invest in multiple organizations including Mountain Projects, Community Care of Western North Carolina, NC Farmworkers Project, Access East, and the Charlotte Center for Legal Advocacy to provide ACA outreach and enrollment services in rural and underserved communities across the state.

2. Listening to residents and sharing stories to activate systems change

What we know: When the ACA was passed in 2010, it changed the nation’s health care system to serve more people. The state needs to pass Medicaid expansion—it is the only health insurance option for many low-income North Carolinians.

The state’s to-date decision to not close the coverage gap impacts working people who are struggling to access health care without insurance. Decision-makers and residents need to hear their stories.

What we’re doing: To close the Medicaid coverage gap, our 2019 investments have included support for communications campaigns that broadly share information about individuals who remain uninsured and what will happen if the state accepts or declines Medicaid expansion. These campaigns are led by grantees NC Child, the North Carolina Justice Center, and the North Carolina Rural Economic Development Center.

3. Giving nonprofits and community members space to innovate

What we know: We believe in the capacity of residents to identify challenges and opportunities to help their communities thrive. Our grantmaking approach includes piloting and testing new ideas that come from residents and organizations working closely with people on the ground to gather evidence on an approach’s effectiveness, as well as incubating and trying innovative strategies that, while unproven, sow the seeds for change. Public confusion around ACA enrollment deadlines, requirements and processes has created a need for these kinds of creative solutions.

What we’re doing: Our investments in ACA enrollment efforts have helped spur several innovative practices:

    • North Carolina nonprofits like Legal Aid coordinated a phone line that anyone in the state could call if they had ACA questions or needed to find in-person assistance.
    • Navigator groups developed a central scheduler where nonprofits could see every enrollment event in the state and make appointments for people online.
    • Several enrollment organizations, including Pisgah Legal Services, are collaborating to build a robust volunteer outreach infrastructure.

A better future

“Increased access to quality health care and economic opportunities helps communities thrive, and research shows that expanding Medicaid delivers both.” –Dr. Laura Gerald, Trust president

We are committed to equitable access to care so that all North Carolinians have the same opportunities to be healthy and thrive. Inequities in health outcomes—by race, class and geography—must be eliminated.

While these are tough issues with no single solution, we can work toward a more equitable future by supporting proven programs like the ACA and by expanding Medicaid to bring health care coverage to 365,000 North Carolinians.