Column: Would Medicaid Expansion Lead to Better Health Care and Better Business? | Columnists

Lindsay M. Keisler

At the Catawba County Chamber, we aim to serve as a strong pro-business voice, advocating for free enterprise and working alongside local government to ensure a friendly business environment that is necessary for all businesses in Catawba County to Catawba are growing and sustaining.

Two major issues affecting businesses repeatedly come to the surface of our impact surveys with our partners: the lack of available and qualified talent to meet the demand for employment and the rising cost of employees, including health insurance premiums. Many factors come into play as to the cause of each of these critical issues faced by businesses. However, recent data has shown that both problems are compounded by the coverage gap. The coverage gap consists of individuals earning too much to qualify for Medicaid but too little to qualify for a subsidy in the health insurance market.

Statewide, 76% of those in the coverage gap are working; of the remaining 24%, many have a medical disability or are on the fringes of the job market because they’ve decided it’s not worth giving up their health insurance to get a job. In Catawba County, 14.2% of workers have no health care coverage.

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One solution to closing the coverage gap that has been adopted by 38 states and is now being seriously considered by the North Carolina General Assembly is to expand Medicaid.

The Catawba County Chamber took no position on this issue; however, our business-friendly public policy standards are guided by our Guiding Principles adopted by our Board of Directors. One of those guiding principles states, “The Catawba County Chamber supports policies that make health insurance affordable and accessible, and create insurance options, especially for small businesses.” With this in mind, we are committed to learning about the implications of this proposed solution for businesses and, therefore, we remain open to all possible remedies for this problem.

Recently, our advocacy task force heard a presentation on the business case for Medicaid expansion by Erica Palmer Smith, executive director of the 152-member statewide Care4Carolina coalition. This coalition was formed to observe the impact of Medicaid expansion in other states and the potential impacts this policy may have on North Carolina. Palmer Smith reminded the task force that those of us who are currently insured are paying for the uninsured through higher health insurance rates and cost shifting to subsidize the charitable care our hospitals provide. She presented data that showed that the total workforce has increased in states that have already made the decision to expand Medicaid, which has attracted more workers available for business and industry. Additionally, we learned that North Carolina residents are already paying for Medicaid expansion in the other 38 states that have expanded Medicaid through our federal taxes.

One of the main objections raised by most concerns the significant financial repercussions that we risk having as a State in the event of an expansion. Palmer Smith explained that North Carolina taxpayers will bear no additional burden as the federal government will pay 90% of the cost of the expansion and hospitals will cover the remaining 10%. The expenses our hospital partners will incur will be less than they currently have to spend on unpaid care for those who are currently uninsured, therefore their burden will eventually decrease significantly. Additionally, we learned that as part of the US bailout, the federal government will provide states with a new incentive: a 5% increase over two years in the federal matching rate for Medicaid. For North Carolina, that would mean an influx of about $1.7 billion over the next two years. Official estimates put the cost of closing the Medicaid coverage gap at $700 million over this period, leaving $1 billion for the state to invest in other worthwhile projects.

Proponents say expanding Medicaid would be the complete solution, providing coverage for about 600,000 North Carolina residents, a third of whom have children under 18, and including about 9,900 people in North Carolina County. Catawba, which are currently uninsured. They also say it would support and boost small businesses and enable them to cover themselves and provide insurance for their employees. While North Carolina enjoys the same benefits seen in other expanding states, employer-sponsored health insurance premiums may see lower rates, in some cases by as much as 25%, and the number of workers available will increase. Finally, they say that a healthy workforce is a more productive workforce. Those living with untreated or chronic illnesses will have access to the care needed to manage their illness and stay in the workforce.

Several weeks ago, a bill was introduced by a group of Senate Republicans led by North Carolina Senate Pro Temp President Phil Berger (R-Eden). Rolling out the new bill that would close the coverage gap, Berger said, “We need coverage in North Carolina for the working poor…without creating problems for the state budget.” Medicaid expansion, he explained, “has evolved to the point where it is good state fiscal policy.” The bill passed the Senate by a 44-1 vote and was supported by Catawba County Senator Dean Proctor.

As the process unfolds and the House considers Medicaid expansion, the Catawba County House will listen — both the conversation in the General Assembly and right here at home. As always, I appreciate the opportunity to hear from local business leaders around this or any other issue, so contact me at [email protected]

Lindsay M. Keisler is President and CEO of the Catawba County Chamber.

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