amna: North Carolina is now the
40th state to expand medicaid
under the affordable care act.
The bipartisan expansion, signed
into law last month, comes after
a decade of Republican
resistance in the state.
As John yang reports, it will be
life changing for some uninsured
north carolinians and their
providers, but not all.
John: Tucked away in a shopping
center on winston-salem's
southwest side, nonprofit united
health centers is a lifeline for
its patients.
>> So we have about 10 exam
rooms.
John: Pediatrician Veronica
Wiltshire, the center's chief
medical officer, says across
three locations it serves 6000
patients.
Most are black, hispanic, or
Latino.
The nearly 80% of patients who
don't have insurance pay on a
sliding scale.
In one place, patients can see a
doctor, get prescriptions
filled, and receive dental care.
They can even enroll in
medicaid, the federal and state
health insurance program for
those with low incomes.
>> Our patient population, it's
all about easy access.
So if we can prevent them from
going one other place, because a
lot of them have to take a bus.
John: Access to health care has
been a challenge for low-income
residents of North Carolina, one
of 11 states that hadn't
expanded medicaid coverage under
the affordable care act, until
now.
Last month, governor Roy cooper,
a Democrat, signed a bill passed
by the republican-ontrolled
legislature expanding medicaid
access in the state.
>> We have a medicaid expansion
bill.
John: When it's implemented, the
program will be open to families
and individuals whose incomes
are lower than 138% of the
federal poverty line, about
$20,000 for an individual.
Before expansion, most adults
without children or a disability
weren't eligible at all, no
matter how low their income.
>> Patients are going to be able
to come to see their doctors
without having to worry about
health care costs.
A lot of times in the population
of patients we serve, it's
either, should I buy food for my
family, should I pay my rent, or
should I buy the medication?
John: It's a dilemma uhc patient
twakeena Simmons, a nursing
assistant, knows all too well.
Her employer-provided health
insurance is inadequate, but
she'll qualify for medicaid
under the expansion.
>> The dentist, you know,
they're kinda pricey, and then
the doctor, pricey.
Medicine, definitely pricey.
John: And clinics like uhc will
benefit, too.
In all, the expansion, and a
one-time federal bonus, is
expected to bring in $8 billion
a year for the state's health
care providers.
The state government's
contribution to the cost of
expanded coverage will come from
hospitals, not taxpayers.
>> Hello, hello, hello.
John: Just days after the bill
was signed, doctor Wiltshire was
part of an advocacy day at the
state's capitol.
>> Can I please give you a hug?
>> Sure.
I love hugs.
John: The key message to
lawmakers?
Thank you.
>> I know you've been working on
this for many, many, many years.
John: State representative Donny
lambeth is a former hospital
executive.
Since 2017, he'd been trying to
get his fellow Republicans, who
controlled both legislative
chambers all those years, to
pass expansion.
>> Early on people just did not
understand it.
We also had changes in attitude
towards Obamacare and medical
expansion.
John: So it was an education
process to get your from the
Republicans on your side?
>> Exactly.
When you first talk about
expansion it is like -- and this
is what they said to me -- oh
no, we're expanding another
government entitle program.
But this does not cost the state
any money.
John: And some Republican
lawmakers say they were were
persuaded to vote for expansion
because most of those who will
gain coverage are employed.
Like Evita bass, who works in
child care in Hillsborough and
didn't qualify for medicaid
under the old rules.
You're an assistant director
here?
>> I am.
John: Work full time?
>> I do.
John: But no health insurance.
>> No health insurance.
John: Are you constantly worried
about, what happens if I get
sick?
What happens if I have an
accident?
>> Yes, it is a constant worry.
Life for me, when I was growing
up, my mom always preached about
going to your annual visits,
making sure that you get checked
out.
And working in daycare, you can
probably imagine we come across
a lot of germs, so it's very
hard to keep yourself up there.
But I do what I have to do so I
don't have that doctor bill.
John: Last year, bass, who is
30, had emergency surgery that
left her out of work for a
month, and stuck with more than
$36,000 in debt, an expense
medicaid would have helped pay.
>> One thing I've always live
by, better late than never.
You kind of just gotta roll with
the punches.
Granted, I wish it would have
came a little bit earlier.
John: If bass qualifies under
medicaid's new income
requirements, as she believes
she will, she says she'll enroll
as soon as possible.
And then how quickly are you
going to make that appointment
for a checkup?
>> As soon as they approve me.
I already have my primary care
doctor that I want to go back
to.
And I'm excited.
John: When North Carolina's
medicaid expansion is fully
implemented, an estimated
600,000 will gain access to
health coverage.
But that doesn't mean there
won't still be people in north
Carolina without insurance.
>> There's still going to be a
huge need for safety net
organizations.
John: Krista woolly runs the
community care clinic of Rowan
county in the Piedmont region of
central North Carolina.
>> A lot of our patients will
come in here and go to the
dentist, they'll go to the
doctor, and they'll pick up
their prescriptions.
John: It's a totally free clinic
for county residents who don't
have insurance and make less
than three times the federal
poverty line.
>> We have 1.1 million uninsured
folks in North Carolina.
What we hear is that medicaid
expansion will cover about half
of that.
So we'll still have 600,000,
700,000 people without insurance
and without the ability to
afford ACA.
John: Kenneth small is one of
them.
He is the entire staff of the
Salisbury, North Carolina
landscaping business he owns.
>> I have been to actual
insurance groups that
try to find you the best deal
that they can.
You can't afford to pay the
premiums that they want.
John: So he relies on the clinic
for health care and for most of
his prescriptions, including
insulin for his diabetes, and
five cholesterol medications.
After quadruple heart bypass
surgery in 2017, the clinic also
helped him lower a nearly
$70,000 hospital bill to $6000.
>> I've never paid out of pocket
to come here.
Anything.
So they they're filling a large
gap between people who are
making too much money to qualify
for medicaid and can't afford
insurance.
And that's where I fall in.
John: Because everyone thinks
that, well, with Obamacare and
with expanded medicaid, we've
taken care of the uninsured
problem.
>> Yeah, no.
There's still a bunch of
uninsured out.
>> We sent you for the stress
test to get a better idea of
your heart.
John: Dr. Amy Wilson is the
clinic's medical director.
With the expansion of medicaid,
you may lose some patients.
>> Yes.
And that's great.
I would love for there to not be
a need for me still, but
unfortunately, I think there is
still going to be.
John: Back at uhc in Winston
Salem, Dr. Veronica Wiltshire
also knows that not all the
clinic's patients will qualify
for expanded medicaid.
>> Did she start school already?
John: But she says the increased
revenue from medicaid will help
all the clinic's patients.
>> Just to build up a mental
health department or hire more
dentists in our clinic.
We can hire a patient navigator
who will be able to help our
patients fill out their forms,
you know, educate our patients.
In health centers, all the
revenue that we receive goes
back into the health center.
John: North Carolina could start
enrolling new patients later
this year, a step, supporters
say, toward improving the health
and well-being of hundreds of
thousands of residents.
For the "Pbs newshour," I'm John
yang in winston-salem, north
Carolina.
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