(The Center Square) – Recent research shows states that have not expanded Medicaid experience higher levels of medical debt, suggesting a focus on expansion in the North Carolina General Assembly during the current session could benefit thousands in the state struggling with medical bills.
Medical debt is among the leading causes of bankruptcy in North Carolina and elsewhere, and research from the Urban Institute last year illustrates how that reality correlates with Medicaid expansion.
The institute examined credit bureau data on 10 million consumers to investigate where people are more likely to face collections for medical debt and why.
“We find that 79 out of the 100 counties with the highest levels of medical debt in collections are in states that have not expanded Medicaid under the Affordable Care Act,” the institute reported. “These counties are mostly concentrated in Georgia, North Carolina and Texas.”
A dozen of the 100 counties are in North Carolina, where Treasurer Dale Folwell has repeatedly highlighted the impact the current health care system is having on taxpayers.
Folwell noted in a December forum in New Bern that up to 44% of families in eastern North Carolina counties are in medical debt collections. Folwell has also pointed to reports that show the average worker loses 20% of their paycheck to health care costs, while nearly 40% of Americans are cutting back on food, utilities, and other necessities to pay health care bills.
The problem stems from North Carolina’s health care monopoly. Research suggests expanding Medicaid could also help to address the issue by increasing coverage for minorities, those with multiple chronic conditions, low-income residents, and others with highest rates of medical debt.
“On average, more than 36% of consumers in these (top 100) counties have a medical debt in collections recorded in their credit report compared with only 14% nationally. The populations of these 100 counties are more likely to be without health insurance (14.8% uninsured versus 8.8% nationally) and more likely to have six or more chronic conditions (20.5% versus 17.7% nationally),” according to the Urban Institute. “Finally, these counties have lower incomes on average ($57,825 versus $88,607 nationally) and a higher share of non-Hispanic Black residents (23.6% versus 12.1% nationally).”
In North Carolina, counties with the highest rates of medical debt collections include Greene, Lenoir and Anson, with rates of 46%, 44.7% and 41.6%, respectively.
Republicans in majorities of the General Assembly have long resisted Medicaid expansion, a goal of Gov. Roy Cooper since taking office, but changed course last year when the Senate approved the move along with other changes to improve access. The legislation did not pass the House in 2022, but both Speaker Tim Moore, R-Cleveland, and Senate Leader Phil Berger, R-Rockingham, expect to move on similar legislation this year.
Republican resistance to expansion centered on finances in prior sessions, and a continued federal incentive could be key to passage in 2023, Moore said.
“I don’t think the money is going away at the federal level,” he told the Charlotte Regional Business Alliance on Monday. “I think the 90-10 match is there and that is what makes it palatable to do it.”
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