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On the 13th Anniversary of the ACA, North Carolina Becomes the 40th State to Expand Medicaid After Years of Republican Obstruction

By March 23, 2023No Comments

North Carolina Expands Medicaid, Giving 600,000 Residents Access to Affordable Health Care

Washington DC — Today, on the 13th anniversary of the Affordable Care Act (ACA) being signed into law, North Carolina became the 40th state to expand Medicaid, extending affordable health care to 600,000 North Carolinians. This move will especially help low-income workers, moms and children, people with disabilities, and Black, Brown, Indigenous, and rural residents. 

Before today, North Carolina was just one of 11 states that have refused Medicaid expansion. Democratic Governor Roy Cooper has fought tirelessly for Medicaid expansion, making it one of his central priorities since taking office in 2017. Already, about 3.5 million North Carolinians rely on Medicaid and the ACA for health coverage, or 33 percent of the state population. In addition to securing coverage for those who need it, this measure will strengthen the economy, boost support for rural hospitals and other safety net providers, relieve hardships for families living in poverty, and — together with policies that focus on other social and structural determinants of health — reduce gaps where people can’t get the health care they need to thrive if they live in certain places or are of certain backgrounds.

In response, Protect Our Care Executive Director Brad Woodhouse issued the following statement: 

“Governor Cooper, Democratic lawmakers, and advocates fought tirelessly for North Carolina’s Medicaid expansion for years — and now, on the 13th anniversary of the ACA being signed into law, they got it over the finish line. This is a victory for North Carolinians and a victory for the 600,000 individuals and their families who will now have access to lifesaving care. Medicaid expansion is especially significant for moms and kids, people of color, folks living in rural areas, people with disabilities, and other communities who face extreme barriers to accessing care and suffer worse health outcomes. This is a critical step to increase coverage and make health care more affordable.

“Even as Republicans in Washington try to gut the Affordable Care Act and Medicaid, this bipartisan action shows what can happen in the states after years of gridlock because the people demanded it.”


More North Carolinians’ Lives Will Be Saved. According to the Center on Budget and Policy Priorities, Medicaid expansion saved the lives of 19,200 older adults aged 55 to 64 between 2014 and 2017. A study published in the Journal of Health Economics found that Medicaid expansion reduced mortality in non-elderly adults by nearly four percent. Medicaid expansion will insure over 365,000 North Carolinians, saving them millions of dollars and increasing access to quality and affordable health care.

North Carolinians Will Receive Expanded Services. Medicaid expansion has helped patients access preventive care, including colon cancer screenings. Expansion also increased patient access to kidney transplants and made diabetes medication more affordable for low-income patients. The program was also tied to earlier diagnoses of colorectal cancer and reducing diabetes-related amputations.

North Carolina Will See Reduced Racial Disparities in Health Care. The ACA led to historic reductions in racial disparities in access to health care, but racial gaps in insurance coverage narrowed the most in states that adopted Medicaid expansion. States that expanded their Medicaid programs saw a 51 percent reduction in the gap between uninsured white and Black adults after expansion and a 45 percent reduction between white and Hispanic adults. There is evidence already that North Carolina’s adoption of Medicaid Expansion will not just follow these trends, but secondarily increase economic activity throughout the state and reduce economic inequities as well.

North Carolina’s 4.6 Million Rural Residents Will Secure Better Care. The uninsured rate for low-income adults dropped from 35 percent to 16 percent in rural areas and small towns in states that expanded Medicaid. Investigations into North Carolina have found areas in the western part of the state will see uninsurance rates drop by over 8 percent, with that number being even higher for those without a high school education. Research also confirms that rural hospitals in Medicaid expansion states are 62 percent less likely to close, and 75 percent of vulnerable rural hospitals are in non-expansion states.