A nurse provides assistance to a patient undergoing a mammogram. (Photo by Tom Werner/Getty Images)
North Carolina is one of states with the most improved health care systems, a national research and policy group concluded in a new report.
North Carolina was the top state among a dozen of its neighbors in the southeast for people receiving the right health care at the right time and being able to avoid hospital stays and emergency department visits by receiving timely care, according to a Commonwealth Fund report released Wednesday.
The report measured the differences in health and access to health care between low-income people and people with higher incomes. On that measure, North Carolina ranked 10th among the 12 southeastern states and 43rd in the nation. The state ranks slightly below the national average in overall performance, according to the report.
The Commonwealth Fund releases a report each year ranking states’ health care systems and the health of their residents. This year, it ranked states on 50 measures such as rates of insurance coverage, out of pocket medical expenses, and premature deaths from preventable causes. Most of the data used for this year’s report is from 2023, before Medicaid expansion fully kicked in in North Carolina and provided more than 600,000 low-income adults with health insurance.
The Affordable Care Act provided both subsidized health insurance and the chance for states to expand Medicaid by enrolling more low-income adults without dependent children in the government insurance plan.
Since the ACA was enacted, fewer adults report that costs kept them from seeing a doctor.
The percentage of North Carolina adults who reported that there was a time in the previous 12 months that they didn’t go to the doctor when they needed to because they couldn’t afford it dropped from 18.5% in 2013 to 10.8% in 2023. The national average in 2023, excluding Pennsylvania and Kentucky for which there is no data, was 11.7%.
“Every state saw a reduction in their number of uninsured adults in the last decade,” David Radley, senior scientist at the Commonwealth Fund, said in a video conference call with reporters Tuesday.
“The coverage gains can largely be attributed to the Affordable Care Act that made Medicaid available to more people and that helped many low- and middle-income people afford the cost of health coverage purchased from federal and state-run health insurance marketplaces. Not only did these provisions help more people get coverage, fewer people skipped getting care that they needed because of its cost,” he said.
These gains are threatened by proposed federal Medicaid cuts and coming increases to marketplace insurance costs, the report said.
Congressional Republicans have plans to impose work requirements on Medicaid enrollees as a way to reduce costs.
In their limited use in other states, Medicaid work requirements did not lead to increased employment. Rather, people who were working lost their health insurance because they had trouble documenting their work hours or because they didn’t know about the need to do it.
Implementing work requirements will come with substantial administrative costs, said Sara Collins, senior scholar at the Commonwealth Fund.
“The irony of these changes is that most people who will be impacted are already working,” she said. “The reporting requirements will be the thing that really does lead to people disenrolling and becoming uninsured.”
Additionally, federal measures enacted during the COVID-19 pandemic that reduced premiums for people who purchase insurance through an ACA marketplace are set to expire at the end of the year. Millions of people are expected to drop their insurance coverage because they won’t be able to afford it.
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