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 PROBLEM.RE OF THE UNINSURED >> 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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