We have not yet fulfilled the promise of Medicaid expansion.
By Dawn Daly-Mack
I live in Northampton County, a rural community. We don’t have an urgent care center. Our story of what it’s like to receive healthcare is a common one in rural communities like ours: When people get sick, or need to see a specialist, they often have to go all the way to Raleigh or Durham.
Last year, North Carolina finally expanded Medicaid to deliver life-saving healthcare coverage. Specifically, around 600,000 North Caroliniains who earn too much for traditional Medicaid coverage but too little to afford private health insurance now can gain access to lifesaving care.
But coverage and access to healthcare doesn’t mean that healthcare can actually be delivered, especially in rural areas. Rural North Carolinians make up nearly 40% of those who have just gained coverage because of expansion.
But rural areas don’t have nearly enough providers —or, in some cases, any at all — to actually provide the healthcare that people need close to home, where they need it most. In several counties, all of them rural, hospitals have closed, leaving communities without access to life-saving medical care.
For those who have died and hospitals that have shuttered, Medicaid expansion came far too late.
In Northampton, some basic care needs are met by our regular clinic, Rural Health Group. But when it comes to more specialized needs, people struggle to find care. As a nurse, I have seen how a lack of providers in our community affects issues like mental health.
One key feature of North Carolina’s Medicaid expansion is called Tailored Plans, which allow people to receive treatment for mental or behavioral health issues and chronic conditions all under one plan. They even include access to a care manager, who can help make appointments and coordinate the logistics of treating complex health conditions.
Tailored Plans will make a difference for many people throughout the state, no doubt. But in rural communities, their success depends on what doctors and facilities are actually available. We know we don’t have enough, which means many rural North Carolinians will still go without the care they need.
So what do we do? Just as we know that better jobs are not going to simply materialize in our communities, we know this will be something we will have to fight for.
It’s going to be the community here in Northampton who will make it happen. We need to advocate for more: more clinics and more providers to deliver the healthcare that Medicaid covers. When new businesses set up shop, we should ask them to invest in the community’s health, knowing that they will benefit when all of us have access to the care we need.
I realize this is an election year, and I have a request for those seeking office: don’t come into our communities and tell us what you’re going to do. Ask us what we need—and be prepared to listen before you start talking. In my community, we need clinics and clinicians.
Medicaid expansion was only a start. Let’s deliver on its promise.
