Medicaid coverage has expanded in North Carolina. Why did it take so long?

Last week, North Carolina became the 40th state to expand access to Medicaid. Given that the expansion option has been available to state governments for nearly a decade, why has this taken so long?

Expanding Medicaid through the Affordable Care Act hit its first big snag when General Assembly members balked at the price tag and felt the ACA would soon go away, leaving states with the tab. But advocacy organizations began making the case to legislators that counties, as well as rural hospitals, were suffering through lack of coverage for their constituents.

By demonstrating the impact expansion would have on the working uninsured, and showing the added revenue healthier workers would bring to each community, what were initially “No” votes, slowly began turning to “Yes” votes. And then came the federal government’s nearly $1.8 billion signing bonus.

Abby Emanuelson is the executive director of Care4Carolina, a statewide non-partisan coalition that’s been committed to expanding Medicaid for nearly 10 years. She says getting to yes came down to education and language.

"Our legislative leaders were saying, ‘No way, no how, we’re not going to expand. Don’t even come into our offices and say Medicaid expansion,’" says Emanuelson. "And so that’s one of the reasons why the terminology for Care4Carolina has always been closing the coverage gap. And we had several legislators that said we’re all for closing the coverage gap, but we don’t want to expand Medicaid."

Since the passage of Medicaid expansion, Emanuelson says she and her colleagues are leveraging their remaining resources to strengthen implementation and enrollment efforts.