North Carolina health insurance access gap is real and sustained






COURTESY CANDICE GRANT
Candice Grant of Charlotte, who suffers from lupus and kidney disease, can’t afford the cost of health insurance through the federal marketplace and earns too much to qualify for Medicare.

Candice Grant takes 10 pills in the morning and eight at night to control lupus and fight kidney disease. She also takes vitamins and other supplements regularly.

Grant, a 51-year-old small business owner in Charlotte, can’t afford health insurance through the federal marketplace because it costs too much. Her husband, Keith, an independent information technology contractor, doesn’t receive any health coverage from his job.

Therefore, they spend about $400 to $500 out-of-pocket a month for Grant’s medications depending on if they are offered a good discount through the prescription drug company GoodRx. It doesn’t include Keith’s health expenses or when she has to go in for routine doctor appointments.

When Keith receives a good contract, it’s a bit easier to afford but it is still a “hefty bill.”

“They turn into monthly bills, my medicine, seeing an OB-GYN, seeing the vision specialist,” said Grant, founder of the writing business The Word Artisan and works as an evening assistant for her youngest son, who was diagnosed with autism and epilepsy. “I would say that as small business owners it can be a challenge. It can really be a challenge, I would say because you have to make sure that you have enough income to meet what can actually be a pretty pricey expense, but it’s a necessary expense so you have to do it.”

Over a decade ago when health coverage was less accessible, Grant applied online to find a family insurance plan. But soon she discovered it would cost $1,600 a month, with $800 to cover her husband and three kids and an extra $800 because of her lupus. They opted to pay out of pocket.

With the state switching to North Carolina Medicaid Managed Care last July, some people are still struggling to get health coverage. Under the new health system, a person on Medicaid can afford coverage for $10 or less per month. But what happens to people who earn too much to enroll in the federal health insurance program but don’t earn enough to afford private insurance?

North Carolinians who earn too much to qualify for Medicaid but too little to qualify for a subsidy through the healthcare marketplace fall into the health coverage gap.
About 14% of non-elderly workers are uninsured in Mecklenburg County, which is higher than the state average at 13%.

Medicaid expansion could help nearly 500,000 residents in the state receive insurance and not have to pay a monthly premium.

“We have far too many people that are in that Medicaid coverage gap,” said NC Sen. Natalie Murdock. “I believe North Carolina is one of 11 states that failed to expand and I’m really hopeful that we will get a handle on that here in North Carolina.”

In 1996, Grant was diagnosed with lupus and kidney disease 10 years later. There is a possibility lupus could have triggered the kidney disease which her family has a history of.
In 2006, after an unexpected kidney failure, she was rushed to the hospital to start dialysis. Later, she was transferred to the dialysis center to finish treatments. A social worker told Grant and her husband that she should consider applying for emergency Medicare to cover future health expenses.

But by this time, she had already accumulated nearly $80,000 in medical expenses. When the Grants were unable to pay the minimum monthly bill, it affected their credit, and they had to go to court to explain why they couldn’t afford to pay. In the end, they received a judgment against the claim and now they pay per month on this bill as well.

When the emergency Medicare had finally kicked in, it covered some of Grant’s expenses such as her doctor appointments. Meanwhile, she was put on the waiting list for a new kidney. In November 2011, she was given a kidney transplant.

“I cannot put into words how grateful I am to receive that transplant,” Grant said. “I’m very protective of my kidney. I’ve always been this way. I was wearing masks well before the pandemic came about. I’m not risking any kind of infection.”

People who fall into the health coverage gap are turned away when they apply for Medicaid or a subsidy through the healthcare marketplace. For instance, a single person with one child who earns $15,000 a year won’t qualify for Medicaid because he or she earns too much and won’t qualify for a subsidy because she must earn at least $17,240. A private insurance plan would cost $265.93 if the person lived in Mecklenburg County, meaning they either pay out of pocket for a private plan or go without.


If the state moved to Medicaid expansion, 64,281 people in Mecklenburg County would gain coverage according to a report by Care4Carolina. Closing the gap would create an additional 3,751 new jobs in the county with more than $11 million in revenue.

“If North Carolina were to expand Medicaid, the federal government has promised an additional 5% on our total Medicaid population,” said Peg O’Connell, the chairperson of Care4Carolina. “So instead of paying 66%, they would pay 72% for two years, that would bring an additional $1.7 billion to North Carolina that we could use to offset the cost of Medicaid expansion. We could use it for anything we want.”

With more than 700 cases of opioid overdoses in the county in 2019, Medicaid expansion would improve public safety by helping more people find treatments for mental health and substance disorders. The expansion would also help to offset county spending on inmate healthcare costs.

Grant, the mother of three, is healthy now. She enjoys yoga, reading, and spending time with her family. With health insurance so expensive in the United States, Grant said it shouldn’t be so expensive.

“We need to recognize that health care should be a basic right,” she said, “and it should not be that people have to make decisions about how they’re going to live their lives based around health care. It’s just ridiculous.”

Aaliyah Bowden, who covers health for The Post, is a Report for America corps member.

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