A national study on Medicaid expansion found that at least 1,400 North Carolinians may have died between 2014 and 2017 because the state has not expanded coverage.

The report released Wednesday by the Center on Budget and Policy Priorities joins an increasingly crowded cottage industry of Medicaid expansion studies.

Medicaid currently serves 2.2 million North Carolinians. Several studies have determined that between 450,000 and 650,000 North Carolinians could benefit from expansion.

Center researchers determined that in the 33 expansion states as of 2017, at least 19,200 lives were saved from potential premature deaths.

Meanwhile, in the 17 non-expansion states at that time, there was an estimate of 15,600 potential premature deaths.

“The lifesaving impacts of Medicaid expansion are large: an estimated 39% to 64% reduction in annual mortality rates for older adults (ages 55 to 64) gaining coverage,” the researchers said.

Life-saving efforts in expansion states include: getting regular health check-ups; making prescription drugs affordable to obtain, particularly for individuals with heart disease and diabetes; earlier stage diagnosis of cancer; and getting surgical care consistent with clinical guidelines.

Researchers also found decreases in: individuals not taking prescription medicine due to cost; one-year mortality for patients diagnosed with end-stage renal disease; individuals screening positive for depression; and individuals lacking a primary physician or outlet for care.

“This new evidence, that thousands of lives are at stake, should give states that have not yet expanded Medicaid one more reason to do so,” researchers said. “It should also finally put to rest claims that Medicaid doesn’t provide quality coverage.”

In a separate report from the center, senior research analyst Matt Broaddus said that “while uncompensated care costs fell in all states, states that expanded Medicaid .... saw both larger coverage gains and larger drops in uncompensated care: a 55% fall in uncompensated care costs on average, compared with an 18% fall in states that did not expand Medicaid.”

For North Carolina, the percentage of uncompensated care costs as share of hospital budgets slipped from 6.85% in 2013 to 6.6% in 2016. That represented an overall $41 million reduction.

By comparison, Medicaid expansion states experienced an average drop from 5.1% to 2.3% in the same time period.

Limited expansion bills

Only one Medicaid expansion bill has been addressed in the N.C. legislature since Republicans gained majority control in 2011.

House Bill 655, sponsored by Rep. Donny Lambeth, R-Forsyth, contains a work or community volunteer requirement of up to 80 hours per month for some recipients, as well as a monthly Medicaid coverage premium based on 2% household income.

Although House Democrats have opposed the two controversial requirements, including failing to have them removed from the bill, they appear willing to accept them as a means for advancing a form of Medicaid expansion.

The work requirements have been held up by federal judges in at least Arkansas, Kentucky and New Hampshire. The Trump administration is appealing the rulings in Arkansas and Kentucky. Arizona and Indiana have chosen to back off — at least temporarily — implementing the work requirement provisions that the Centers for Medicare and Medicaid Services has approved for them.

HB655 was placed on the House floor agenda for 36 consecutive sessions before being removed by House speaker Tim Moore on Sept. 11 at Lambeth’s request. It was intertwined with the Republican state budget compromise that Democratic Gov. Roy Cooper vetoed on June 28.

House GOP leadership conducted Sept. 11 its highly controversial veto override votes for the state budget and Medicaid managed-care startup funding with most Democratic members absent from the chamber.

A House Health committee meeting was dedicated Sept. 18 to HB655.

Twelve amendments attached to HB655 on the House floor were addressed and four approved before recommending the bill to the Rules and Operations committee. Five amendments were withdrawn after Lambeth said he would discuss the potential legislation with their sponsors.

House Rules has not taken up the bill since.

Moore told legislative online media outlet The Insider in October that “the day (Lambeth) wants to move the bill, he has the green light to do so. ... He really wants it to be more of a consensus bill” in both chambers.

GOP Senate opposition

Senate leader Phil Berger, R-Rockingham, and other Senate GOP leaders have expressed stiff opposition to any Medicaid expansion legislation, citing concerns that the federal government may not maintain its 90% match of expansion administrative costs even though it has for 37 expansion states to date.

Both sides have relied on Medicaid expansion reports as dueling proxies for their reasoning for and against supporting HB655.

Several studies, foremost by the Kate B. Reynolds Charitable Trust and the Cone Health Foundation in June, have shown that between an additional 634,000 North Carolinians could be covered through expansion.

That 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.

“Every community stands to benefit from Medicaid expansion,” said Dr. Laura Gerald, president of 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.”

Berger’s office, meanwhile, has touted a report from the National Bureau of Economic Research that addressed the socioeconomic status of Medicaid expansion participants.

The report examined 12 non-expansion states, including North Carolina, and nine blue, red and purple expansion states. A purple state is one without a strong partisan identity.

The Affordable Care Act makes Medicaid available to households with incomes below 138% of the poverty line, or nearly $36,000 for a family of four.

The NBER report found a significant number of individuals receiving Medicaid-subsidized health coverage in the nine expansion states whose household income made them ineligible for expansion coverage.

They were, however, eligible for coverage through paying premiums in the federal health marketplace exchange.

Researchers said many applicants in the nine expansion states may have under-reported their household income to become eligible, or did so because they anticipate lower household income by the time they would be eligible.

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