[Editor’s note: A new “must read” report from the North Carolina Poverty Research Fund provides what is perhaps the most damning assessment yet of North Carolina’s failure to follow the lead of dozens of other states by expanding Medicaid under the terms of the Affordable Care Act. The following summary/introduction was adapted from a release authored by the Fund’s director, UNC law professor Gene Nichol.]
In late 2016, the North Carolina Poverty Research Fund issued a significant report on state access to health care entitled, “Putting A Face On Medicaid Expansion in North Carolina.”  The study not only heavily documented the dramatic economic, social and health costs resulting from the state’s decision to refuse the proffered expansion of Medicaid under the Affordable Care Act, but it focused (somewhat atypically) on the stories of patients, families, doctors, nurses and other health care providers to illustrate, more concretely, the often tragic impact of the denial of expanded coverage on the lived experience of Tar Heels.
Unfortunately, in 2020, North Carolina remains one of a small number of states (14) continuing to reject Medicaid expansion. Now, a new study, “Violence Against the Poor: The Consequences of North Carolina’s Failure to Expand Medicaid,”  updates our 2016 report – concentrating again on the healthcare ramifications of the legislative determination and using the narratives of patients and physicians to illustrate the fateful consequences of denying health care coverage to hundreds of thousands of low income Tar Heels. We urge you to review the report and distribute it to your colleagues.
This is from the introduction to the report, which was written by Heather Hunt, poverty fund research associate, and UNC Gillings Public Health graduate students Allyson Corbo, Sara Correa, Rosa Greenberg and Paige Logan:
The human toll of North Carolina’s failure to expand Medicaid is immeasurable. In the first four years that expansion was available nationally, 1,400 North Carolinians between the ages of 55 and 64 died because of the state refusal to expand. Going forward, over one thousand lives will be saved every year if Medicaid is expanded in North Carolina. These numbers, grave as they are, only hint at the extent of individual suffering and loss. Nor do they begin to tally the larger harms to North Carolina’s healthcare system or its economy.
And this is from the conclusion:
Medicaid expansion is, quite literally, a lifesaver. Thousands of North Carolinians have died for want of health insurance. Medicaid expansion would spare thousands more from premature and unnecessary loss of life. Across the state, residents would gain access to reliable care, improved health, and all the benefits that greater mental and physical wellbeing entail—longer periods of employment, more secure families, the opportunity to live a full life. Medicaid expansion would enable healthcare providers to better serve their patients and reach a larger number of underserved patients. It would bolster critically important yet fragile rural hospitals, to say nothing of the larger savings and economic benefits to be gained. The failure to enact Medicaid expansion is a self- inflicted wound on the state, its healthcare system and its people.”
The “Violence Against the Poor” report  includes substantial interviews with Evan Ashkin, Pradeep Arumugham, Steven Luking, Peter Morris, Denise Monaghan, Bryan Parrish, Jaclyn Kiger, Lisa Harrison as well as many anonymous patients and health care providers. It explores the challenges of rejected Medicaid in rural hospitals and struggling community health centers, and includes a notable case study from the Granville Vance Public Health Department concerning two rural counties on the state’s northern border.
Dr. Steve Luking, a family practitioner from Reidsville, hit the mark for many who were interviewed:
I saw a sign a lady was holding that said, ‘no Medicaid expansion is violence against the working poor.’ I saw that and I was like, ‘it is.’ People are dying, and people are being hurt, and people are going without care, and people’s lives are being shortened.”
The report’s authors note that:
Even before the coronavirus struck, the American healthcare system was deeply unequal. As Zadie Smith put it, ‘Death comes to all – but in America it has long been considered reasonable to offer the best chance of delay to the highest bidder.’ The punishment for those who can’t place a bid is harsh: circumstances diminished by poor health and lives cut short.”