By Peg O’Connell
Why should we close the coverage gap, let me count the ways? [Apologies to Elizabeth Barrett Browning].
If you are a regular reader of this blog, you know that I, and other contributors, have put forth a variety of well supported reasons that the North Carolina General Assembly needs to get on the stick and close the coverage gap.
First, there are the 750,000 people (since COVID struck) who have no affordable option to buy health insurance for themselves or their families. Second, there will be a huge positive economic impact on our state’s economy—over $4 billion in new federal funding will come to North Carolina, annually. That is like passing a CARES Act every year. Third, closing the gap will help stabilize our rural hospitals and medical practices. Having more insured patients will lessen the uncompensated care. And fourth, and I should probably have put this first, it is the right thing to do! People are suffering and enacting a policy that will close the gap by opening up our state’s Medicaid program can help so many during this very difficult time in our state’s history.
But still, nothing happens. Grrrr!
Well, here’s another reason, that will impact those who are asking “why should I care about people in the gap, I have good health insurance?” Closing the coverage gap will lower private health insurance premiums in North Carolina! Say what? Yes, that is correct. The more people who are insured, the less uncompensated care, the less cost shifting to those of us who are lucky enough to be insured.
According to a 2018 issue of the Journal of Health Economics, closing the health insurance coverage gap helps reduce individual health insurance premiums and states that have closed their coverage gap experience an average of 11-12% lower rates across health insurance plans than states that have not found a solution. In fact, the latest information coming from Johns Hopkins School of Public Health and Georgetown School of Public Policy indicates that states that recently closed the coverage gap experienced a 15-16% reduction in their average individual insurance rates.
You can trust me on this. I am an old [former] insurance lawyer, and this is a big deal. When businesses are looking at setting up shop or relocating to a new state, you can bet your shamrocks, that they look at the cost of doing business and at the top of the list is how much it costs to insure workers. Can we really afford to be so cavalier with the prospect of new businesses choosing North Carolina? I think not.
Even if none of the heart strings arguments sway you, then think of your own wallet or think of our state’s economy and our competitiveness. To borrow a phrase, the North Carolina General Assembly needs to “just do it!”
 Health Economics. 2018;27:1877–1903.