Read the op-ed originally published in the Greensboro News & Record.
North Carolina’s moderate weather, politics, and policies make us a beacon for brisk economic development and a strong health care system. One consequence of living in a growing state is that we don’t always look under the hood to understand the hidden machinery driving our prosperity.
Medicaid is a central engine of that success. This is particularly true in rural regions of our state. But threatened federal cuts could throw sand in the gears of our economic vitality.
Medicaid is a health insurance program jointly funded by the state and federal governments to provide medical care and other lifesaving services to nearly 3 million North Carolinians. Most Medicaid members are children, pregnant women and people with disabilities. People who live in rural communities are more likely than those living in urban areas to benefit from Medicaid.
Medicaid is also a major funder of nursing home care for seniors. To put it in perspective, Medicaid pays for more than one-third of all births in North Carolina, it covers nearly half of all children in our state and it funds two-thirds of the care for nursing home residents. Nationally, Medicaid is the largest single source of funding for mental health and substance-use treatment.
Payment shifts and disproportionate uninsured and underinsured rates have shuttered rural health centers across the country. When the community hospital in Belhaven, N.C. closed, for example, its leaders cited the lack of Medicaid expansion as the primary culprit. These closures increase driving times for care and tend to overwhelm nearby hospitals, causing poorer outcomes. Studies consistently show that greater Medicaid coverage leads to higher rates of profitability for rural hospitals. This impacts the broader economy as well. One study found that for every 1,000 Medicaid enrollees, 125 jobs are created. About half of these jobs are in health care, but other job sectors such as retail and construction also benefit.
In 2023, legislators from both political parties — led by Forsyth County Rep. Donny Lambeth — joined with former Gov. Roy Cooper to extend Medicaid to adults who earned too much for Medicaid but too little for private health insurance plans. In its first year of implementation more than 600,000 North Carolinians enrolled in coverage. This step was critical to support the profitability of rural hospitals and combat the opioid crisis. Current Gov. Josh Stein, another longtime champion of extending Medicaid coverage, warns that a reduction in the federal cost-sharing for this program could immediately undo our state’s expansion.
The American health care system is a complex weave of public and private partnerships. If we pull out important threads, then the entire garment will unravel, leaving North Carolinians without the cover they need to weather the inevitable storms ahead. State and federal funds and a strong health care infrastructure have proven essential in helping the people of western North Carolina recover from the devastation of Hurricane Helene. Medicaid is the most critical seam holding together our rural health and economic systems.
This is why we are concerned about potentially devastating Medicaid cuts in the federal budget. We have already seen a 90% reduction in federal grants that support the nonprofits providing unbiased advice on insurance and Medicaid enrollment.
The two of us have spent our careers working to improve the health and well-being of North Carolinians, one as a physician focused on caring for whole communities and the other at the Kate B. Reynolds Charitable Trust, a statewide health foundation. We know first-hand the beauty and vibrancy of our state’s rural counties.
Medicaid is key to building thriving communities. No one should seek to undermine our collective accomplishments. Instead, we should look to build on the bipartisan progress that makes our state great.
Asssociate Professor Viviana Martinez-Bianchi, M.D., FAAFP, is director for health equity for the Duke Department of Family Medicine and Community Health and LATIN-19 co-founder and board chair. Views expressed in this op-ed are the individual’s and are not presented on behalf of Duke University or the Duke University Health System. Adam Linker is vice president of programs of the Kate B. Reynolds Charitable Trust.
Read the Greensboro News and Record Op-ed here.