Francis Koster: Members of the North Carolina House need to clean their glasses

Published 12:00 am Sunday, June 12, 2022

Back in 2013, it became possible for all states to expand Medicaid health insurance for lower income people. North Carolina was among 12 states that did not. Our politicians made a financially expensive and values-based moral mistake. Some North Carolina politicians seem intent on continuing to make the same mistake today.


Last week, after 13 years of stalling, the North Carolina Senate passed a bill to finally expand Medicaid in North Carolina.   Members of the North Carolina House of Representatives are indicating they will try to defeat that effort.


Politicians can look at this issue through two different sets of eye glasses – the cold lens peering into our state’s bank book, or the emotional lens focused on the crying family member burying their parent or child. Republican members of North Carolina’s House of Representatives need to clean their lenses, because they are not seeing clearly out of either pair of glasses.


Through the financial lens, the failure of our North Carolina Legislature to pass Medicaid expansion in 2013 has cost our state $40 billion in federal funding.[i],[ii]


Add to that the fact the hospitals in our state lost another $11 billion because they had to deliver uncompensated care that Medicaid expansion would have paid for[iii] – and as a consequence 6 North Carolina rural hospitals went broke and had to close[iv]. All the people who worked at those hospitals lost their jobs, and in addition to making it harder for constituents to get medical care, unemployment claims paid for by the state budget rose.


And that is just the financial picture.


Through the lens of Republican “family values” and “protect the children,” the situation is a bigger disgrace.


Since we could have expanded Medicaid, 10,677 children born in North Carolina died before their first birthday[v]. Based on many studies done in the 38 states that did adopt Medicaid expansion, sick babies get better care, and 1,884 of those North Carolina under-one-year-old children’s deaths would have been prevented the by Medicaid expansion[vi].


I bet our politicians sent sympathy notes.


And the death rate drop was not limited to children. In those states that expanded Medicaid, because the poor sick could get regular examinations, cancer and heart screenings, and could afford to get their prescriptions filled, premature deaths among older adults dropped an average of 50%.[vii],[viii]


These politicians are behaving in a way that does not reflect their stated goals of fiscal responsibility and family values. They are sabotaging the very people who elected them.


Please reach out to your N.C. State Representative, and ask them to vote to expand Medicaid.

Tell them they should follow the money, and their heart, be the role model leaders we badly need in our country today, and walk their talk.

Dr. Koster spent his career in health care working for one of the nation’s largest specialty pediatric healthcare systems. He is now president of a not-for-profit calling attention to pollution that harms children. You can see that project at






[1] Total births 2013-2021 = 1,570,000 times the Mortality Rate of 6.8 per 1,000 live births ( minus 1,570,000 times the mortality rate of 5.6 per 1,000 live births in states that did adopt Medicaid Expansion = 1,884


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