Uninsured patients say North Carolina’s Medicaid expansion is a life-changing development

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• Amna Nawaz:

  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 Yang:

  Tucked away in a shopping center on Winston-Salem's southwest side, nonprofit United Health Centers is a lifeline for its patients.

• Dr. Veronica Wiltshire, Chief Medical Officer, United Health Centers:

  So we have about 10 exam rooms.

• John Yang:

  Pediatrician Veronica Wiltshire, the center's chief medical officer, says, across three locations, it serves 6,000 patients. Most are Black, Hispanic, or Latino. The nearly 80 percent 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.

• Dr. Veronica Wiltshire:

  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, you know?

• John Yang:

  Right.

  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-controlled legislature expanding Medicaid access in the state.

• Gov. Roy Cooper (D-NC):

  We have a Medicaid expansion bill.

  (CHEERING AND APPLAUSE)

• John Yang:

  When it's implemented, the program will be open to families and individuals whose incomes are lower than 138 percent of the federal poverty line. That's 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.

• Dr. Veronica Wiltshire:

  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 Yang:

  It's a dilemma UHC patient Twakeena Simmons, a nursing assistant, knows all too well. Her employer-provided health insurance is inadequate, but she will qualify for Medicaid under the expansion.

• Twakeena Simmons, Patient:

  The dentist, they're kind of pricey, and then the doctor pricey, medicine definitely pricey.

• John Yang:

  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 states health care providers. The state government's contribution to the cost of expanded coverage will come from hospitals, not taxpayers.

• Dr. Veronica Wiltshire:

  Hello, hello, hello.

• John Yang:

  Just days after the bill was signed, Dr. Wiltshire was part of an advocacy day at the state capitol.

• Dr. Veronica Wiltshire:

  Can I please give you a hug?

• State Rep. Donny Lambeth (R-NC):

  Sure.

  (LAUGHTER)

• State Rep. Donny Lambeth:

  I love hugs.

• John Yang:

  The key message to lawmakers? Thank you.

• Dr. Veronica Wiltshire:

  I know you have been working on this for many, many, many years.

• John Yang:

  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.

• State Rep. Donny Lambeth:

  Early on, people just did not understand it. We have also had changes in attitude towards Obamacare and Medicaid expansion.

• John Yang:

  So, it was really an education process to get your fellow Republicans on your side?

• State Rep. Donny Lambeth:

  Exactly. And I think, when you first talk about expansion, it is like — and this was what they said to me — oh, no, we're expanding another government entitlement program.

  The neat thing about this program is, it doesn't cost the state any money.

• John Yang:

  And some Republican lawmakers say they were persuaded to vote for expansion because most of those who will gain coverage are employed, like Evita Bass, who works in childcare in Hillsborough and didn't qualify for Medicaid under the old rules.

  You're an assistant director here?

• Evita Bass, Uninsured North Carolina Resident:

  I am.

• John Yang:

  Work full time?

• Evita Bass:

  I do.

• John Yang:

  But no health insurance?

• Evita Bass:

  No health insurance.

• John Yang:

  Are you constantly worried about, what happens if I get sick? What happens if I have an accident?

• Evita Bass:

  Yes, it is a constant worry. I know, 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 day care, 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 the doctor bill.

• John Yang:

  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.

• Evita Bass:

  One thing I have always live by, better late than never. You kind of just got to roll with the punches. Granted, I wish it would have came a little bit earlier.

• John Yang:

  If Bass qualifies under Medicaid's new income requirements, as she believes she will, she says she will enroll as soon as possible.

  And then how quickly are you going to make that appointment for a checkup?

• Evita Bass:

  As soon as they approve me.

  (LAUGHTER)

• Evita Bass:

  I already have my primary care doctor that I want to go back to. And I'm excited.

  (LAUGHTER)

• John Yang:

  When North Carolinas 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.

  Krista Woolly, Executive Director at Community Care Clinic of Rowan County: There's still going to be a huge need for safety net organizations.

• John Yang:

  Krista Woolly runs the Community Care Clinic of Rowan County in the Piedmont region of Central North Carolina.

• Krista Woolly:

  A lot of our patients will come in here and go to the dentist, they will go to the doctor, and they will pick up their prescriptions.

• John Yang:

  It's a totally free clinic for county residents who don't have insurance and make less than three times the federal poverty line.

• Krista Woolly:

  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 will still have 600,000, 700,000 people without insurance and without the ability to afford ACA.

• John Yang:

  Kenneth Small is one of them. He is the entire staff of the Salisbury, North Carolina, landscaping business he owns.

• Kenneth Small, Patient:

  I have been to actual insurance groups that try to find you the best deal that they can. And you just can't afford to pay the premiums that they want.

• John Yang:

  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 $6,000.

• Kenneth Small:

  I have never paid out of pocket to come here anything. So, they're filling a large gap between people that are making too much money to qualify for Medicaid and can't afford insurance. And that's where I fall in.

• John Yang:

  Because everyone thinks that, well, with Obamacare and with expanded Medicaid, we have taken care of the uninsured problem.

• Kenneth Small:

  Yes. No.

  (LAUGHTER)

• Kenneth Small:

  There's still a bunch of uninsured out.

  Dr. Amy Wilson, Medical Director, Community Care Clinic of Rowan County: We sent you for the stress test to kind of get a better idea of your heart.

• John Yang:

  Dr. Amy Wilson is the clinic's medical director.

  With the expansion of Medicaid, you may lose some patients.

• Dr. Amy Wilson:

  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 Yang:

  Back at UHC in Winston-Salem, Dr. Veronica Wiltshire also knows that not all the clinic's patients will qualify for expanded Medicaid.

• Dr. Veronica Wiltshire:

  Did she start school already?

• John Yang:

  But she says the increased revenue from Medicaid will help all the clinic's patients.

• Dr. Veronica Wiltshire:

  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, educate our patients.

  So those kinds of resources would help. We will be able to — because, in health centers, all the revenue that we receive goes back into the health center.

• John Yang:

  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.