Tuesday, 04 February 2014 00:00

Renewing the call to expand Medicaid in NC

Written by  Laura Mussellwhite | News Observer

Last year’s decision by McCrory and company to say “thanks, but no thanks” to $2.3 billion – a sum paid almost entirely by the federal government for N.C. Medicaid expansion – fueled many of the Moral Monday protests our state has become famous for.

Soon after, I began asking physician colleagues around our state about their patients, mostly the working-class poor, who were most affected by the decision. One woman in rural North Carolina suffers from a debilitating anxiety disorder, brought on by her child’s illness. As the single breadwinner, she cannot afford to see her doctor more than once every few months, despite daily struggles with agoraphobia.

Another patient is a middle-aged, small-business owner recently diagnosed with an autoimmune disorder that has required complicated blood product exchanges almost weekly, yet he cannot afford to buy health insurance – through the state exchange or otherwise.

Reflecting on my own patients I provide primary care for, several have refused all preventive health care until their 65th birthday kicks in. This includes refused mammograms, colonoscopies, diabetes screenings and the shingles vaccine. And the list goes on.

At the moment, a formidable 318,710 adults in North Carolina are working for incomes less than $11,500. These folks are too poor to qualify for subsidized tax credits for private insurance and do not qualify for Medicaid under our current standards.

In refusing the expansion, McCrory not only turned down much needed money for our state, but also might have shortened the lives of our working-class poor. A recent study in the noteworthy New England Journal of Medicine compared death rates in several states that expanded Medicaid to those in states that did not. Their results were clear: States that expanded Medicaid saved lives – almost 3,000 lives yearly in the three states studied.

Our working friends and family members who fall into a marginal income category become sick every day – and almost always unexpectedly. It begins with unintended weight loss, a pain in the chest or a slurring of the words. They work full-time jobs, just like we do. Yet, when they become ill, they bear extortionate costs with little help, and many may be forced to declare bankruptcy. Access to care is also often delayed in this group – a harbinger for advanced illness and poor prognosis.

McCrory’s rejection of N.C. Medicaid expansion is like kicking a dead dog; it makes no sense, and most folks would not approve.

On the sunny side, there is still time. Time to sway political hardliners who cannot see the greater good, but who must – in order to save lives among our working-class poor.

Link to original article from

Laura Musselwhite is a freelance writer and doctor at Duke University. Her views do not necessarily represent those of Duke. Reach her at This e-mail address is being protected from spambots. You need JavaScript enabled to view it


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