While looking for work, he lived in his car for 10 weeks. After two traffic accidents in 2015, related to poor vision brought on by undiagnosed diabetes, he lost the vehicle that was his home.
Without health insurance, Messenger got medical care from a free clinic and medicines from a free pharmacy in
Messenger is one of about 300,000
The gap grew out of the decision three years ago by Gov.
This fall, as McCrory and his Democratic opponent, Attorney General
As part of an assessment of how the state is doing on several fronts heading into the
The state's increase in the obesity rate has slowed recently, bringing it almost even with the national average. There has been a slow reduction in infant mortality, following a national trend, but the state still trails the
That statistic is related to the state's decision not to expand
McCrory calls Obamacare "an unmitigated disaster for
Opinion split on ACA
Like McCrory, many Americans believe the ACA has been a failure.
But since the law took effect, about 20 million uninsured Americans have gained health insurance. And in
Still, signs of distress are increasing. Citing huge losses on ACA business, UnitedHealthcare and Aetna have pulled out of the online marketplace in
Skyrocketing premiums are one of the problems cited by ACA critics. But one recent study concluded that rejecting
Premiums for marketplace plans were 7 percent lower in states that expanded
But Garfield added that "a very large body of research" shows that expanding
Barriers to care
Studies show that not having insurance creates barriers that make it hard for people to get medical care when they need it.
"People delay getting care they need," said
Doctors who treat poor and uninsured patients see the effects regularly.
"When I was in practice, I saw a couple of patients every day who would have benefited from
"Many of them skipped appointments because they didn't have the money for the copay...or they wouldn't have the copay for their medications, so they wouldn't take them regularly," she said.
Saxe often saw children on
As a result, "you have a population of women of child-bearing age, some of whom didn't come in and get contraception, and that puts them at risk for having another baby at a short interval."
Saxe recalled one patient in her 40s who had been discharged from the hospital after having several strokes but had failed to keep followup appointments because she didn't have insurance or the cash to pay. "She could have died waiting to see me," Saxe said.
Indeed, an estimated 455 to 1,145 unnecessary deaths a year can be attributed to
Consumer advocates who call for
For example, expanding
-- Would create more than 40,000 jobs in the state, according to a 2014 analysis.
-- Would have enabled the state to collect more than
-- Would protect the financial health of hospitals, especially those in low-income areas, by saving millions in uncompensated care, according to a 2015 study. In
"If you can prevent all that stuff, it's better for the individual and for the state. ... It requires folks to think about the long-term impact," Riley said.
McCrory and Republican lawmakers oppose
State legislators say they've been frustrated by a string of
The state proposes to stop paying for each doctor's visit or procedure. Instead, it would contract with private insurers or groups of providers and pay them a flat rate for each patient. The contracting groups would cover any cost overruns, giving them an incentive to provide effective care at the lowest cost.
About half the 25,000 uninsured veterans in
Studies show that most people who would be covered by
In response to questions from The
Cooper said the state should approach
Losing federal dollars
Some advocates for
"North Carolinians are already paying taxes on the federal level, so why shouldn't we bring back those dollars to
'No safety net'
Brown cited a patient who's a "perfect example" of someone who could be helped by expansion. For years, the 50-something man has been a self-employed handyman. But in recent years, a spinal condition has limited his ability to work.
Brown has treated the man -- for cash at a discount -- but he is uninsured and can't afford to see a neurosurgeon for an evaluation, including an MRI of his cervical spine. The patient is down to working two days a week because he has trouble with balance that makes it dangerous for him to climb ladders, Brown said.
"He is continually getting worse (and) spending himself into poverty," Brown said. "If this turns out to be a correctable condition, it would have been fixed and (he would have been) back to work and being fully productive, building things, hiring other people to help him, creating jobs.
"If he had been helped early, all of this could have been avoided," Brown said. "There's no safety net for this guy."
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