A Doctor’s Perspective: Why North Carolina Needs Medicaid Expansion

Written by Dr. Michelle Stowe Ong of Statesville, North Carolina

“The boss is kind to me and lets me use crutches at my work site,” is what the patient explained to me. He is 44 and has already lost one leg to diabetes. He has been in the hospital and his sugars are starting to come into the range of normal, but I have to tell him it is too late. He will lose his other leg to surgery as well. This is devastating– he works two jobs and has three kids at home. Losing the second leg will make it so he cannot work at all. 


I tell him he has to be better with his medication to control his diabetes. He knows this, but he tells me he simply cannot afford it all the time. He is uninsured. 


Along with 600,000 other North Carolinians, this man lives in the healthcare coverage gap– making too much to qualify for Medicaid but far too little to afford to buy insurance on his own. Overwhelmingly the people living in this gap are from working families. They are farmers, firemen, veterans, childcare workers, fishermen, and small business owners. 

Dr. Ong of Statesville, North Carolina.

For over a decade, medical professionals like myself have been asking our elected officials to expand Medicaid because everyday we bear witness to our state’s failure to do so. North Carolina is one of the few remaining states that has not expanded Medicaid, causing real harm to our citizens and at a real cost to us all. Recently, I met with a waitress who got COVID and ended up in the hospital for a week. We were able to stabilize her situation, but for her to go home she would need oxygen. Because she was uninsured, she couldn’t get oxygen and instead had to remain in our care for 32 long days. Not only did this take her away from her family and her work, at $1,500 a day it cost our state much more than it would have had we helped her become insured. 


Not only would expanding Medicaid bring millions of dollars into our state from the Federal government, it would also protect small town and rural hospitals like mine. Healthcare providers simply can’t absorb the cost of treating uninsured patients. North Carolina ranks third in the nation for hospital closures with 11 closures since 2005. Rural hospitals are 85% less likely to close in states that have expanded Medicaid than in those which have not. Insured or uninsured, healthcare facility closures impact us all. 


But far more important than the financial impact is the human impact. I entered my field to care for and heal my neighbors, but it is easy to become discouraged or feel compassion fatigue when the odds are so stacked against them. 

I think of a 55 year old gentleman who was in COVID respiratory failure. He asked me when he could get vaccinated, and I gently asked him why he had not already gotten the shot. He told me it was because he was uninsured and could not afford it. I explained to him the vaccine was free, but he said it was not the cost of the vaccination he worried about. He had heard that sometimes people got ill after being vaccinated and he could not afford the risk of getting sick. This broke me– here he was in respiratory failure because our health insurance system made him take a gamble. He died three days later. 


The loss of a leg, the loss of a job due to an extended hospital stay, the loss of a life– these would have all been preventable if the North Carolina General Assembly had expanded Medicaid. Fortunately, the opportunity to do so remains. Our representatives can act now to pass Medicaid expansion and bring healthcare to people throughout our communities with the stroke of a pen. 


As a doctor who is doing everything within my power to provide care to North Carolinians, I am asking my elected officials to do everything within their power and expand Medicaid now. 

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