After waiting over a week, Governor McCrory signed into law the bill rejecting Medicaid expansion in North Carolina. The HIV community is disappointed in the governor’s lack of leadership and vision. We had hoped for better.
Last Friday, I gave a presentation on health reform at the UNC Infectious Diseases Friday conference. In the audience were HIV physicians, providers, students, researchers, and others involved in HIV/AIDS work. After I updated the group about the status of the “No Medicaid Expansion” bill, someone in the audience asked whether there was any chance Governor McCrory would follow the lead of other Republican governors, including Christie of New Jersey, Brewer of Arizona, Kasich of Ohio, and Scott of Florida, and veto the bill. I replied that I doubted it. No one I talk to had seen any sign that Governor McCrory would show leadership and compassion on this issue. Later, on my drive back to Durham, I thought more about that question, and realized there was still a little part of me that held out hope that maybe my answer was wrong. Maybe McCrory would come around.
Yesterday, hours before McCrory signed the bill, I was giving another presentation. This time, I met with an HIV support group in Durham. I was giving my quick and dirty update on health reform for non-wonks, and was interrupted with a question from a young woman in the group. I’ll call her Sherry. Sherry gets her HIV care at Lincoln Community Health Center’s Early Intervention Clinic. She conscientiously takes her life-saving HIV medications every day. She gets her HIV drugs through the AIDS Drug Assistance Program, for which she is grateful. But when it comes to other medications and services, she faces great challenges, applications, paperwork, and lot of lost time. Thanks to her HIV medications and expert treatment at Lincoln, she is healthy and able to work part-time. But she doesn’t have enough income to afford insurance and has been repeatedly turned down for Medicaid, even though her income is below 100% of the federal poverty level. The problem? She can’t qualify for the existing Medicaid program because she isn’t the parent of a minor child and, thankfully, isn’t disabled.
I told Sherry, “You are a poster child for Medicaid expansion.” And that’s right. Sherry is exactly the kind of person who would benefit from getting full insurance coverage through Medicaid. With Medicaid, she could get drugs for her other conditions without having to beg. She could go to the hospital without running up a bill that will ruin her credit, making it difficult for her to rent an apartment or get credit to buy a car or house. She could access specialty care when needed. Sherry’s doctors and the hospital would like it if she could pay for her care, too.
Sherry also asked me if she maybe she could get help to buy insurance in the new marketplace that will come online January 1, 2014. She was glad to know that at least she couldn’t be refused because of her pre-existing condition, and wondered if she could get the financial assistance that will be offered to help people afford insurance from the marketplace. Again, I had to disappoint her. Because the law was originally designed with Medicaid expansion being mandatory, everyone assumed that people under the poverty level would have Medicaid. So the law didn’t include financial help for people under the poverty level (currently $11,490). So people like Sherry are left uninsured.
Sherry asked what she could do. All I could say was that she needs to let the people making decisions know how their decisions affect people like her. Sherry was ahead of me on this one. She’d called Governor McCrory’s office repeatedly in the last few weeks to tell him she needs Medicaid. Sherry and the rest of the folks in the support group wondered if the lady answering the phone even relays their messages. I had to tell them that she probably does. But their voices don’t seem to be the ones the governor is listening to.
The proof came later in the day when McCrory signed the bill his people wanted. No Medicaid for Sherry in 2014.
News & Observer: McCrory misses chance to lead on Medicaid issue