A celebration of the Affordable Care Act at an uncertain time for Medicaid

A celebration of the 15th anniversary of the Affordable Care Act came with warnings of potential cuts to Medicaid.

The Affordable Care Act, known as Obamacare, was signed into law about 15 years ago. Now, 1.6 million people in North Carolina are insured under some aspect of the law. Nearly 1 million people have subsidized health insurance through the ACA, and about 640,00 adults are enrolled in Medicaid under expansion, which the ACA allowed, and state leaders approved in 2023. 

Congressional Republicans are contemplating federal budget cuts that could erode Medicaid services and force people who enrolled in expanded Medicaid off of their health insurance. 

Republicans in the U.S. House are considering Medicaid cuts of up to $880 billion over 10 years. That would translate to a $27 billion funding decrease for North Carolina over 10 years.  

Medicaid improves residents’ health and brings billions into the state’s economy, state Medicaid director Jay Ludlam said Monday at Martin Street Baptist Church in Raleigh. 

“Despite widespread support for North Carolina Medicaid, Congress is proposing massive cuts that will hurt North Carolina,” he said. 

The federal government pays 90% of the cost for people covered under Medicaid expansion. In North Carolina, hospitals pick up most of the rest. None of the costs come from state coffers. 

Congress could decide to reduce federal support for people covered under expanded Medicaid. If that happens, current state law says that Medicaid expansion will end, and people who use the insurance would lose it. 

Other Medicaid reductions under consideration in Congress would mean “a cut to the number of people who are eligible, a cut of the number of services available, and a cut to what providers are paid,” Ludlam said. 

“Bottom line, it means fewer people getting fewer services, and providers getting paid less,” he said. 

In all, 3.1 million North Carolinians use Medicaid as their health insurance. 

Forty percent or more of the residents in 29 mostly rural counties are enrolled in Medicaid, according to the state Department of Health and Human Services. Older adults and people with disabilities account for 21% of the state’s Medicaid enrollment but 54% of Medicaid spending, according to DHHS. 

Gov. Josh Stein and his administration have been warning about the consequences of Medicaid cuts for citizens and hospitals.

The NC Navigator Consortium, which offers people advice about Medicaid plans and ACA marketplace insurance plans, is already facing a massive budget cut.  

In February, the Centers for Medicare & Medicaid Services announced a 90% cut in navigator services grants. For the NC Navigator Consortium, that means a reduction from $7.5 million to $750,000, said director Nicholas Riggs.

The Consortium is designed to provide one-on-one assistance to people searching for insurance coverage. Last year, it provided 124,000 people with one-on-one help, Riggs said. 

In 2017, the last time the Consortium had to absorb a big federal grant cut, it helped only 25,000 people, he said. Now that more people than ever need the Consortium’s help, it doesn’t have the capacity to provide it, Riggs said. 

Jennifer Snowhite of Winston-Salem said she and her husband, both artists, lived without health insurance for years because they couldn’t afford it.

“When the ACA was first introduced, we jumped on board,” she said.

A few years later, her husband saw a doctor for a cough. Later that day, they were told he had two tumors in his chest. 

“To say we were terrified is the understatement of the year,” she said. 

The next day, she attended an ACA open enrollment event at a public library. There, Snowhite said, she sought out a Consortium navigator who worked with her for hours to find the best insurance plan. 

“Thanks to her depth of knowledge of ACA coverage choices, we were able to find a plan to allow him to go out-of-network to see the doctors that he needed,” she said. 

When Snowhite was diagnosed with breast cancer a year later, she didn’t have to worry about insurance coverage. She is now cancer free. 

Her husband’s recovery meant he was able to launch a project that employed 150 people, she said. 

“We are so incredibly fortunate to be the beneficiaries of the ACA as well as the NC Navigators,” she said. “Without you, I fear we would now be a too-typical story of bankruptcy or far worse. Instead, we have so much to celebrate.”