About 634,000 North Carolina residents would gain health-care coverage over the next three years if the state expands access to Medicaid, a new report released today says.

The report, paid for by the Kate B. Reynolds Charitable Trust and the Cone Health Foundation and done by George Washington University researchers, comes as the state’s lawmakers debate expansion of the state’s Medicaid program.

According to the report, if Medicaid were expanded as early as November 2019, 464,000 North Carolinians would gain coverage by the end of 2020; by the end of 2022, that number would increase to 634,000.

Medicaid already serves 2.14 million North Carolinians, representing about 21% of the state population. Another 1.6 million will be enrolled in Medicaid through a new managed-care program that is projected to be rolled out in the state between November and February.

The report determined that expanding Medicaid would create more than 37,000 jobs, including 20,600 in the health-care sector, by the end of 2022, as well as bring in an additional $11.7 billion in federal Medicaid funding from 2020 to 2022.

An earlier report, done in 2014 by the same group, projected 8,962 jobs created and 93,471 more individuals insured by 2020.

“Every community stands to benefit from Medicaid expansion,” said Dr. Laura Gerald, the president of Kate B. Reynolds Charitable Trust. “The evidence shows that closing the Medicaid gap will improve population health, support vulnerable North Carolina families and boost the economy across the major sectors.”

Democratic Gov. Roy Cooper’s attempt to insert Medicaid expansion into the state budget process is expected to lengthen — by weeks or months — approval of a state budget and delay the end of the 2019 General Assembly session. The typical goal is to end the session around the Fourth of July.

North Carolina is one of just 14 states, mostly Republican-led, that has not expanded Medicaid since the passage of the federal Affordable Care Act, also known as “Obamacare.”

Cooper’s budget plan recommends expanding Medicaid “to bring $4 billion into North Carolina’s economy, create an estimated 40,000 jobs and provide more affordable health care for 500,000 people,” according to his office.

The N.C. House and N.C. Senate budget plans do not contain Medicaid expansion, and a budget compromise expected this week from the chambers is not expected to add expansion.

“Regarding the timing of the release, we commissioned the study earlier in the year and it was just completed,” said Susan Shumaker, the president of Cone Health Foundation. “The release is unrelated to the current budget negotiations.”

Local implications

For Forsyth County, the 2019 report projects that 1,772 jobs would be created — the fifth most in the state — and the local economy would gain a $423.7 million benefit by 2022.

For the 14 counties of the Triad and Northwest North Carolina, the projected combined job creation is 7,672, and the economic benefit at $1.68 billion.

There also would be 123,956 new Medicaid enrollees in the 14-county region, including 25,489 in Forsyth County.

“Medicaid expansion is a job creator and can extend health coverage to thousands of previously uninsured North Carolinians who are falling through the gaps in our current system,” Shumaker said.

“States that have already expanded Medicaid are better equipped to tackle critical health-care concerns, like opioid addiction and infant mortality rates, issues that need to be addressed here at home in North Carolina.”

Lawmakers are also at odds over whether North Carolina is missing out of additional federal Medicaid money by not expanding its program.

The report determined that “through their federal tax dollars, North Carolinians are already paying for Medicaid expansion — in other states, like neighbors West Virginia and Kentucky, both of which have significantly lower amounts of uninsured residents.”

Last week, N.C. Senate leader Phil Berger, R-Rockingham, repeated in an opinion piece in The News & Observer of Raleigh his claim that the federal government may not be able to sustain its commitment of paying 90% of the additional Medicaid expansion administrative costs.

The other 10% would be covered by an assessment that hospitals, providers and health insurers have pledged to finance.

Since the GOP super-majorities in both legislative chambers ended with the 2018 general election, Cooper can veto any public bill if he has the unanimous support of the 21 Democratic senators and loses no more than six Democratic votes in the House.

GOP legislative leaders, led by Berger, have chosen not to take up two Democratic-sponsored bills that would expand Medicaid, nor the Republican option introduced April 9 by state Rep. Donny Lambeth, R-Forsyth, that has bipartisan support.

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