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As of Dec. 1, North Carolina becomes the latest state to fully expand Medicaid


Today, North Carolina becomes the latest state to fully expand Medicaid. Jason deBruyn of member station WUNC helps us understand what that means.

JASON DEBRUYN, BYLINE: Irena Johnson helps run a mobile health clinic in Ahoskie, a small town in northeastern North Carolina.

IRENA JOHNSON: The thing that stands out to me the most is transportation.

DEBRUYN: That's why this clinic makes stops all over the county.

JOHNSON: We have a lot of patients that lack transportation, so they can't get into the doctor's office, so we're able to go out to them.

DEBRUYN: Now, Medicaid will cover transportation costs for some patients, but Johnson says this mobile clinic will not go away. In bigger cities, patients can call up a rideshare app. Johnson laughs at that notion for Ahoskie, a town of 5,000 residents.

JOHNSON: There's nothing like that here. No. There's no Uber. There's no Lyft. No. You either have a car, you're walking or the mobile unit is coming to you.

DEBRUYN: Inside, the mobile clinic looks, well, just like a doctor's office.


JOHNSON: Have a seat.

DEBRUYN: It has one of those padded patient chairs common in physician offices everywhere. Johnson preps an inflatable armband to read blood pressure.


DEBRUYN: It also has a wheelchair lift for patients who might struggle up the narrow steps. This mobile clinic is part of Roanoke Chowan Community Health Center. Its CEO, Kim Schwartz, says now that more people will have health insurance, they're expecting 1,500 more patients.

KIM SCHWARTZ: So yes, we'll see an uptick. And yes, that'll have an impact.

DEBRUYN: She knows it will bring in some more revenue and also hopes it will improve the health of her center's rural patients. Like other southern states with Republican-controlled legislatures, North Carolina has long opposed expanding Medicaid as it was tied to the Affordable Care Act or Obamacare. But it did an about-face this year after some lawmakers said it was clear the ACA would not be overturned and the state was forgoing lucrative federal incentives. Starting this week, North Carolina hospitals are getting $2.6 billion because of Medicaid expansion, and more people with insurance is great news for Al Goddard. He runs a small, primary care clinic in the one stoplight town of Colerain. He sees a lot of poor, uninsured patients. If he refers them to specialists or writes prescriptions, he knows he's recommending treatment that's been cost prohibitive for many of them.

AL GODDARD: When a person has a choice between do I pay the light bill and buy groceries, or do I buy medicine? I got to do one or the other.

DEBRUYN: Until now, full Medicaid coverage in North Carolina was only available for low-income residents who are disabled, elderly, children and those who are pregnant through one year after childbirth. Some very low-income parents could also qualify. Starting today, Goddard says hundreds of thousands of North Carolinians who couldn't afford health insurance can now sign up.

GODDARD: At least they can now get their regular lab test. They can come in regularly for their office visits. They have a chance now.

DEBRUYN: There are now 10 states still left that have not expanded Medicaid. Most of them are in the South.

For NPR News, I'm Jason deBruyn in Raleigh, N.C.

(SOUNDBITE OF NATHANIEL BARTLETT'S "OPENING") Transcript provided by NPR, Copyright NPR.

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Jason deBruyn