By Maya Durvasula.
Adam O’Neal, mayor of 2.1 square-mile Belhaven, North Carolina, spent the month of July marching the 273 miles from Belhaven to Washington D.C. in protest of the state’s failure to expand Medicaid.
With the blessing of North Carolina NAACP President Rev. Dr. William Barber, O’Neal set off with the intention of informing President Obama and Congressional leaders about the crisis threatening his coastal community: the creation of a medical desert.
On July 1, non-profit Vidant Health closed the Vidant Pungo Hospital, which served nearly 25,000 individuals in two of the state’s poorest counties, Beaufort and Hyde. Although the hospital was set to be replaced with a 24/7 urgent care clinic, such a facility treats only non-life-threatening injuries and minor illnesses. For all other treatment, including care for all complex and serious cases, nearly 1,500 Belhaven residents, along with other residents of Beaufort County, must travel 30 miles to the nearest hospital. For individuals who live in the eastern part of Hyde County, the nearest hospital is now 80 miles away.
According to a 2014 report by the North Carolina Task Force on Rural Health, the 2.2 million people who live in the state’s 60 rural counties face a greater risk of illness, coupled with shorter lifespans, than people who live in the state’s urban areas. The closure of rural hospitals only exacerbates the disparity in health outcomes.
The Belhaven scenario is playing out in dozens of rural communities in America. According to the National Rural Health Association, in 2013 alone, 14 rural hospitals shut down across the country, creating “medical deserts” in which populations were left without accessible acute medical care.
While there is considerable debate about the causes of rural hospital closure throughout the country, North Carolina’s rural healthcare crisis continues to escalate, in large part, due to the state’s refusal to expand Medicaid. According to a statement issued by Vidant in response to the Vidant-Pungo Hospital closure, North Carolina’s failure to accept federal Medicaid expansion funds made it untenable for them to continue operating a facility that already ran a $1.8 million deficit in 2013.
O’Neal deviated from traditional Republican talking points on Medicaid expansion and called out his own party’s failure to act in the public interest on this key issue. When outlining what he hoped to address during his march and while in Washington, O’Neal wrote, “I will be pushing for Medicaid expansion. Our state’s refusal to accept expansion is taking 2 billion dollars a year out of our state’s healthcare system.”
Health policy analysts across the country have denounced North Carolina’s decision on Medicaid as illogical and tragic public policy. The Urban Institute reports that refusing these funds will cost North Carolina $40 billion over the next decade, while hospitals will lose $11.3 billion, in addition to job losses in the thousands. According to UNC School of Law Professor Gene Nichol, the Belhaven hospital closure is just one of many that we can expect.
On top of lost funds, jobs, and providers, the state is still obligated to foot part of the bill for Medicaid expansions in other states. According to an analysis performed by McClatchy, North Carolina will end up spending more than $10,000 to cover the costs of healthcare for low-income people in other states.
The closure of Vidant-Pungo Hospital and O’Neal’s impassioned march to Washington illustrate the degree to which a single community can be moved by the loss of healthcare access.
O’Neal’s crusade for Medicaid expansion is a prime example of the breakdown of party ideology that stems from sheer proximity to an issue. As UNC’s Nichol put it, “The federal government has offered to pay almost the entirety of the health care tab for about a half-million impoverished Tar Heels. We’ve said no thanks. We don’t like the donor.”
While policymakers in Raleigh, ensconced in the protective walls of the State Legislative Building, and Governor Pat McCrory may somehow be able to justify this decision, those arguments fall apart when people like O’Neal are confronted with reality. Here on campus, shielded from the rest of North Carolina by the behemoth that is Duke’s medical center, it is easy to forget that this politicking over healthcare is being actualized on the ground somewhere.
It won’t be long, however, before the rest of the state starts finding itself in equally close proximity to these issues. According to a Harvard Medical School and City University of New York study, Medicaid expansion in North Carolina would have meant 455 to 1,145 fewer people dying annually; 27,044 more diabetics using diabetes medications; and 14,776 fewer individuals with catastrophic medical expenditures. Over the next few years, we can expect to see access to quality healthcare declining across the state, as well as the consequences of deteriorating community health.
Back in Belhaven, O’Neal and the community have made strides toward bringing healthcare access back to their region, following talks with Vidant about re-opening a hospital that would be run by the town. “I’m 100 percent sure we’re gonna get it reopened. It’s just a matter of time,” O’Neal said during a Sept. 9 interview on MSNBC.
For the rest of North Carolina, however, the state’s current refusal to accept Medicaid expansion funding is making rural healthcare a casualty of partisan allegiance. Although community mobilization has prompted progress in Belhaven, the Tar Heel State would be far better served by re-evaluating Medicaid expansion proposals from Gov. McCrory and his allies in the General Assembly. When it comes to healthcare access and availability of life-saving medical treatment, public well-being ought to trump the Republican Party’s distaste for the federal government.