North Carolina’s Medicaid Expansion began Friday, adding an estimated 600,000 people to the rolls. North Carolina Department of Health and Human Services Secretary Kody Kinsley spoke to WFDD’s Paul Garber about what the expansion will mean for rural hospitals. Kinsley begins with a discussion of the recent history of the state’s hospitals that are outside of metro areas.

Interview highlights

On the recent trends in rural hospitals in North Carolina:

"Over the last decade, North Carolina's had nearly a dozen rural hospitals closed. We know that in states that have not expanded Medicaid that we see the closure of hospitals more rapidly. And that just makes sense. People in rural communities are disproportionately likely to be uninsured in North Carolina, you're three to four times as likely to be uninsured. And so if people walking through your door don't have a way to pay, then as a business, you can't stay open. Hospitals have to operate an emergency department. And for many folks that are uninsured, that's the only place they can go to get care. So if you're living in a rural community and you're uninsured, that means your primary care clinics and other providers can't afford to stay open. That leaves the hospital to carry the brunt all by themselves. And after they carried the brunt for a very long time of uncompensated care, you know, the dollars just don't make sense. And then they have to shutter."

On the different types of rural hospitals in the state:

"We have many rural hospitals that are still owned by the county in which they operate. This really grew out of the mid-1900s. There was federal legislation that invested in building hospitals and these were county operated and county run. Over time some of those hospitals turned into their own independent authorities still nonprofits operating by themselves and growing. Atrium hospital started out as the Charlotte Mecklenburg County Hospital Authority, and it's grown to what it is today. Out of that many of those hospitals started to merge together still under a nonprofit status and build broader health systems. So we have obviously Novant [Health], Atrium [Health], a number of other nonprofit health systems in the state, but we still have some of those independent county-operated hospitals. Some individual county hospitals have been taken on to be managed by UNC Health or have merged in, some are being operated by private companies. So it's a real mix across the map." 

How some rural areas are struggling and how improving health outcomes can help:

"Health is everything. Look at a particular focus. For example, about half of the individuals that work in childcare are uninsured. Medicaid expansion will help make it possible for those employees to get access to healthcare coverage and to stay well. That's great for them. It's great for their families, because it's good to have mom and dad to be healthy. But it's also great for their childcare business that they work at. Because now they can show up to work and they can do the job that they love. They don't have to feel pressured to leave the profession that they're passionate about just because they don't have health insurance. They can provide important high-quality, early education to children that all of the evidence reinforces is one of the best investments that we can make in kids and to the future generations in those rural communities. They are also, by doing their job, they allow the kids that they take care of, [their] mom and dad to go to work. Because without childcare, they can't work which is a further investment in their local communities and the employers of their local communities and the economy of their local community. You know, a healthy workforce is a productive one. And we know that the investments of people in the productive work that they do has really compound benefits in our rural communities."

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