COVID-19 is unlike any health crisis our state and country have experienced before. North Carolinians from all walks of life are demonstrating selfless courage and compassion to care for their community. Many are risking their own lives to provide child care for essential workers or to care for COVID-19 patients, despite shortages of protective equipment. In this time of unprecedented hardship and danger, we need our legislative leaders to bring the very same level of extraordinary compassion and courage to the decisions they must face in the weeks ahead. For North Carolina to weather this storm, and build the foundation for recovery, nothing we do can be “business as usual.”

More than a million people in North Carolina are facing a pandemic with no health insurance whatsoever. The financial impacts will be devastating for families, and for our hospitals and health systems. The North Carolina General Assembly adjourned in November with no state budget and no action on legislation to close the health insurance “coverage gap” in North Carolina. Now with COVID-19 wreaking havoc on our state’s economy and our citizens’ health, we are calling on our legislators to take courageous and compassionate action.

The General Assembly should act now to get health coverage to as many people as possible by expanding Medicaid.

One in 10 citizens of North Carolina have no health insurance. Many of them are on the front lines of this pandemic, taking huge risks to help all of us by working in emergency child care centers and grocery stores. More than a quarter of them are parents with children at home. This is the population that Medicaid expansion was designed to cover. The General Assembly should accept the federal Medicaid expansion funds to get these people enrolled. This action will immediately cut the number of uninsured in half in the state, unlocking $3 billion in federal funds for our struggling health systems at a time when those funds are desperately needed.

The high numbers of uninsured people in North Carolina could overwhelm our health care system — especially in rural areas.

Rural hospitals across the state are already stretched beyond limits. Eastern North Carolina’s largest health care provider, Vidant Health, eliminated nearly 200 positions last month, the result of an $18 million budget shortfall for the health system. Vidant Health CEO Dr. Mike Waldrum specifically cited the lack of Medicaid expansion as a major contributor to Vidant’s economic challenges.

High numbers of uninsured patients depend on charity care or the emergency department for their health care needs, crippling health systems’ bottom lines. Seven rural hospitals have closed in North Carolina since 2010. We simply cannot afford to lose any more health care capacity in this state right now.

We need to protect families with children at home.

Before this pandemic, about half of children in North Carolina were living in families at or near the poverty line. For those families, falling ill with COVID-19 — or any serious illness — could be financially devastating. We need to assure our state’s people that they and their family members will be able to go to the doctor if they need to. Whether they are working on the front lines of this pandemic, or they have lost jobs and health insurance through no fault of their own, nobody should have to fear that they won’t be able to afford care if they get sick.

We want to thank Speaker Tim Moore and North Carolina House leaders for convening the House Select Committee on COVID-19, and for inviting public input into their urgent work. But the House can’t act alone. Without the N.C. Senate, there can be no action. We are calling on our state’s leaders to join health care providers, businesses, child care providers, food service workers, home-schooling-while-home-working parents and long-distance teachers, to rise to the colossal challenge that has been set before us all. Together, we will get through this crisis.

Michelle Hughes, M.A., M.S.W., is the executive director of N.C. Child, a statewide nonprofit organization that advocates for policies that give every child the opportunity to thrive. Susan Fitzgibbon Shumaker, R.N., M.H.A., is the president of Cone Health Foundation, a Greensboro-based health funder which focuses on expanding access to health care. View the full letter to N.C. legislators from N.C. Child, Cone Health Foundation and 74 other North Carolina organizations, at

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