Adrienne Harreveld, Duke Write(H)ers blogger, shares her thoughts on Pat McCory, Medicaid and NC politics.
Recently the GOP has been getting a lot of flack for the positions they’ve take on women’s issues, whether it be in Congress or closer to home. But in the good ol’ North State, our Governor, Pat McCrory, has a chance to redeem himself (or at least start the redemption process). Many of us have read or heard about his recent slip-up where he refers to gender studies as only having a place in private schools[i], but if he really wants to be a friend to women and liberal arts education there is something he needs to do first: sign onto Medicaid expansion.
Oftentimes political landscape and legislation reinforces a system and culture that doesn’t mesh well with the ideas of feminists and progressives. How can we really ever make progress on issues like pay discrepancy or more women voices in the media if extreme health disparities between men and women exist? Nearly 40% of women have an ongoing chronic medical condition that requires medical attention compared to 30% of men[ii]. Women have higher rates of arthritis, asthmas, and obesity and are affected by anxiety and depression at twice the rate as men[iii]. By signing onto Medicaid expansion in North Carolina, these disparities will be reduced by allowing low-income women who do not meet the categorical component of being pregnant or having a child access to treatment for chronic conditions, essential preventive and mental health services, and early diagnosis tools.
So how does Medicaid in North Carolina work currently? Basically, you have to fit the income and categorical criteria: 1) Your income has to be at a certain percentage of the poverty level 2) you must either be pregnant or be able to claim a dependent (aka have a kid), or 3) have a disability. Under this system, thousands of low-income women lack access to insurance. Throughout North Carolina, 21% to 30% of women are uninsured, but if the Governor signs onto Medicaid expansion that number is estimated to drop to below 8%[iv]. Under the new Medicaid expansion plan, all low- income women at 133-138% of the poverty level will qualify for Medicaid without having to fulfill the categorical component of having a child or being pregnant.
While Medicaid expansion is not targeted specifically at women, women have the most to gain. An estimated 19 million women (ages 18-64) in the United States are uninsured and the consequences of this are incredibly troubling. Uninsured women are 60%[v] more likely to be diagnosed with late-stage cervical cancer than insured women, they are 30-50% more likely to die from complications from breast cancer and they receive fewer prenatal care service meaning they are more likely to experience detrimental maternal outcomes such as pregnancy-related hypertension and placental abruption[vi]. If our Governor doesn’t want to sign onto expansion, he is further proving he is not an advocate for women (and the rest of low-income North Carolina).
So far 18 states are opting into Medicaid expansion, 10 states are not participating and the remaining states are ranging from likely to participants to rejecting the opt-in. Until recently, it wasn’t clear which way North Carolina would go, but as of Wednesday and the sponsorship of Senate Bill 4, things don’t look good. Senate Bill 4 directs the Department of Insurance to return a $73.9 million grant the U.S. Department of Health and Human Services awarded to North Carolina two weeks ago to build a state exchange- the exchange that would make Medicaid expansion possible[vii]. The bill’s sponsor, Sen. Tom Apodaca (R-Henderson) said in a statement Wednesday "We think it’s time to opt out immediately - to make our feelings known in the legislature." [viii]One thing's for certain, Senator Apodaca is making his ‘feelings’ perfectly clear. By sponsoring Senate Bill 4, he is letting the entire state of North Carolina know that he is perfectly alright with the crippling effects of women being uninsured.
[v] Ferrante JM, Gonzalez EC, Roetzheim RG, Pal N, Woodard L. Clinical and demographic predictors of late-stage cervical cancer. Arch Fam Med 2000;9:439–45.
[vi] Institute of Medicine. Insuring America’s health: principles and recommendations. Washington, DC: National Academies Press;