Expanding Medicaid in North Carolina: A Victory for Health Justice

In a recent interview with Kate Daley, Health Justice Campaigner for Down Home, we explore the significance of Medicaid expansion and its impact on the healthcare system in North Carolina. The expansion, which came after a decade of advocacy, has already shown promising results, opening doors to healthcare for thousands of previously uninsured individuals. Additionally, the financial incentives provided by the American Rescue Plan have paved the way for further improvements in public health infrastructure. However, there is still work to be done to ensure equal access to healthcare for all.

Kate, could you explain the significance of Medicaid expansion and its impact on the healthcare system in North Carolina?

There is no way to understate the significance of this win for working class people in NC.  

By raising the income threshold for Medicaid to $20,120 per year for a single adult (and higher per household member) there are now 600,000 people between ages 19-64 who now are eligible for free health insurance and free health care. These are people who were in the Medicaid gap up until now, meaning that they were not able to afford health insurance, but their income was still too high to receive Medicaid. North Carolina should have expanded Medicaid in 2013 when it first became available through the Affordable Care Act, but our Republican state lawmakers wouldn’t budge until after 10 years of hearing their constituents advocate relentlessly for them to do the right thing, and here we are.  

What steps can be taken to address the remaining Medicaid gap for individuals? And how can we work towards achieving truly equal access to healthcare?

So far, since December 1st, over 314,000 people have been enrolled through Medicaid expansion, with a higher than average rate of people who enroll living in rural counties. This is absolutely life changing for people who can now get the health care that they need and deserve, without facing financial ruin. It also means that money is now going back into rural healthcare systems and hospitals, creating jobs and retaining providers in those areas, while saving lives! 

Even with all of these improvements and investments in health care for our state, the Medicaid gap is far from being closed for people with low incomes. If a single adult needs to make $20,120 or less to qualify for Medicaid, that means that someone making $21,000 per year still does not qualify, and it’s a reality that we cannot simply accept. The threshold for free health insurance should be much higher for people who work low-wage jobs. In fact, Down Home will continue to fight until we have truly equal access to health care through a universal health care system, also known as Medicaid for All.  

What specific challenges do rural areas in North Carolina face when it comes to accessing healthcare? How does DHNC’s Health Justice campaign address these challenges?

We’ve heard from people in rural communities across the state about the challenges that affect them when it comes to health care, and there are several issues that seem to be felt across the board. Women’s reproductive health care is extremely limited in rural areas, and many counties do not have an OB GYN office or a labor and delivery unit. And the political attacks on abortion access in NC are felt hardest in the rural areas of the state. Lack of specialists and even primary care providers who can accept Medicaid is an example of a discrepancy that affects rural communities in our state, that can be addressed at the local level through the creation of provider incentive programs and public/private partnerships. Down Home members have started a statewide Health Justice working group to address these issues through research and advocacy, and through local member-campaigns that will continue to center the needs and voices of our folks.

Another issue that we’ve heard widely from our community members about is the unfairness of health insurance being tied to a person’s employment, but there are not enough jobs offering full-time benefits for working class people. Also, medical debt piles up for people, even if you do have insurance but it’s not enough coverage, with high deductibles and high monthly premiums. We are committed to working together across the state with a strong coalition of justice organizations as we build power in the ongoing fight to win universal health care for all through a public single-payer health care system. 

According to DHNC, everyone — no matter our race, gender, or class — should have access to quality healthcare. Can you explain how your campaign is working to ensure this inclusivity and equal access?

Down Home is committed to fighting for health equity for rural areas, for working class and poor communities, and for marginalized groups who historically have faced discrimination and mistreatment by the medical community. Our health justice campaign will continue to fight until we win universal health care for all so that no one is excluded from health care because of their level of income or zip code. And we will call out the policies and politicians who cater to for-profit corporations at the expense of communities of color and low-income communities, such as pharmaceutical companies who overcharge for insulin and insurance companies who take advantage of the Medicaid and Medicare markets. Our campaign has a lot of work to do and with the recent victory of expanding Medicaid in NC, we are excited to keep pushing for health justice! 

Where does the fight go from here, especially considering the existing and emerging health challenges in the state?

We are excited about drawing the connections in people’s lives who are impacted directly by issues that are interconnected, and fighting for them as a unified movement. People who lack access to affordable health care issues also have children who are students at public schools. The schools know that their students perform better when their families are healthy and have their basic needs met, so we will focus on bringing Medicaid enrollment into public school communities, where we’re already engaging with parents all across the state, to protect and transform our school systems. Climate and environmental health also overlap with health justice where we see the harm being caused by polluting industries, mostly to rural, low-come, and communities of color. A campaign that establishes a protected green space or a recreational park, such as the Granville St. Park that our chapter in Granville County won last year, has a direct impact on health outcomes in that community. So we are building campaigns that are truly intersectional and center the voices of those who are most directly impacted.  


As you can see, The expansion of Medicaid in North Carolina represents a significant step towards health justice for working-class people and marginalized communities, but challenges remain, and Down Home is committed to continuing the fight for universal healthcare and addressing the interconnected issues that affect people’s lives. Through building-multiracial power and dedication to health equity, Down Home is ready to make long-lasting changes that will improve the lives of North Carolinians for years to come.

To get involved in our health justice work at Down Home, reach out to Kate at [email protected] 

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