By Shamar Wilson
Chatham County often referred to as “The Heart of North Carolina” is geographically situated in the center of the state, comprising three towns; Pittsboro, Siler City, and Goldston. As a 14-year Pittsboro resident—who’s utilized the many services offered by my community—my research gravitated towards the accounts of individuals who, like me, have resided and benefited from the services offered by Chatham County. Applying Chatham County Community Assessments (henceforth CCCA), the data found outlines a picture of Chatham; yet, this picture is devoid of the shades, highlights, and colors, that illuminate the socioeconomic disparities evident. Through the use of analyzed interviews from the “Stories to Save Lives” project, the experiences detailed provide depth and in tangent, the additional data constructs a full picture––perspective––of Chatham County. The data revealed that although the implementation of the Patient Protection and Affordable Care Act (henceforth ACA) has improved the health insurance marketplace of Chatham County, socioeconomic barriers create stark differences in access to quality healthcare, which limit the overall effect of the ACA.
Despite North Carolina being one of the twelve states without expanded Medicaid coverage, the ACA accomplished several of its goals,[1] which were “to reform the private insurance market, expand Medicaid to the working poor, and change the way that medical decisions were made.” [2] Additionally, the ACA sought to improve existing public insurance programs such as Medicaid.[3] Specifically, within North Carolina, benefits from the ACA included public health prevention, the Hospital Readmission Reduction Program, the Innovation Center, and the Bundled Payments for Care Improvements (BCPI).[4] Within Chatham County, the ACA yielded insurance marketplace benefits. Serving as an outline, for the picture of Chatham County residents’ access to health insurance, according to the 2010 CCCA, “24.6% of Chatham County residents aged 18 to 64 were uninsured.[5] Comparatively, the 2014 CCCA, revealed that “18% of adults age 18 to 64 were uninsured” and after an additional eight years of the implementation of the ACA,[6] the 2018 CCCA showed that, “the percentage of uninsured adults age 18-64 in Chatham decreased to 12.5% in 2013-2017,” [7] thus the percent of Chatham residents with health insurance has risen since the implementation of the ACA thereby improving the health insurance marketplace.
Although the outline––constructed from improvements to the health insurance marketplace–– does coincide with coverage and therefore more facilitated access to healthcare, the full picture of Chatham County does not represent the current socioeconomic disparities evident that are further exacerbated by race. Providing further depth, to the full picture of Chatham County, the 2020 Spotlight on Health Disparities in Chatham County states:
“Black/African American households are two times more likely and Hispanic/Latinx households are three times more likely to be living in poverty when compared to White non-Hispanic/Latinx households and life expectancy for members of the Black/African Americans population is nearly 5 years shorter than White residents.”
Because socioeconomic status influences access to healthcare––such as the access to public versus private insurance plans, the racial socioeconomic inequities act as a barrier to accessing healthcare, despite the improvements made by the ACA. Although one of the goals outlined by the ACA was to improve coverage of prevention benefits within Medicaid, according to the 2020 Spotlight on Health Disparities in Chatham County:[8]
“A lower percentage of Hispanic/Latinx Medicare female enrollees aged 65-74 in Chatham County get an annual mammogram screening compared to other Chatham County Medicare enrollees of the same age. Additionally, a lower percentage of non-White and Hispanic/Latinx Medicare fee-for-service enrollees in Chatham County had an annual flu vaccination compared to White Medicare enrollees.”
The percentage of non-white Chatham Medicare enrollees contributes additional elements to the picture of Chatham County, because it demonstrates the shortcomings of the ACA, and the marginalized population affected by the gaps in the outline provided.
Another element that provides depth to the picture of Chatham County is the personal accounts made from Galloway Ridge––an affluent retirement community in Chatham County––resident Charles Richard “Dick” Mewarth. As a former physician, when asked about his thoughts on disparities in regards to access to healthcare, Mewarth claimed”
“More of the people that came to my clinic were probably black because they were poor, and if they needed medication or needed a hospital bed, then it was often a real problem to find a hospital that had a bed dedicated to non-paying patients. Who would accept this patient…It was probably a generic problem for all poor people. It’s just that there were more black poor people that came to my clinic than white.” (0:54:33.0)
Furthermore, when asked about his thoughts on the ACA, Mewarth stated
“The distribution of care is unequal so that there are areas where there is more than adequate care and there are far too many areas where the care is sparse.” (1:04:48.1)
As reinforced in Mewarth’s response, the ACA has accomplished several of its goals, in the process of constructing an outline of Chatham County, but the gaps in the ACA are just as much a part of the picture of Chatham County as its successes.
As a community, Chatham “county ranks in the top 10 of North Carolina counties for life expectancy, health behaviors, and health outcomes” but the question is who is actually included in this picture of Chatham County. To continue to construct a full picture of what Chatham County is, policies and initiatives must be implemented to acknowledge and reduce the multitude of populations that aren’t as fortunate as the white affluent residents of Chatham. Nonetheless, each component of Chatham County residents’ access to healthcare should be included in how access is visualized, perceived, and addressed to construct a real image of Chatham.
References
[1] Silberman, Pam. “The Affordable Care Act : Against the Odds, It’s Working.” North Carolina Medical Journal, vol. 81, no. 6, Nov. 2020, pp. 364–69. www.ncmedicaljournal.com, doi:10.18043/ncm.81.6.364.
[2] Silvers, J. B. “The Affordable Care Act: Objectives and Likely Results in an Imperfect World.” Annals of Family Medicine, vol. 11, no. 5, Sept. 2013, pp. 402–05. PubMed Central, doi:10.1370/afm.1567.
[3] Apr 29, Published: and 2010. “Summary of Key Changes to Medicare in 2010 Health Reform Law.” KFF, 30 Apr. 2010, https://www.kff.org/health-reform/issue-brief/summary-of-key-changes-to-medicare-in/.
[4] Silberman, Pam. “The Affordable Care Act : Against the Odds, It’s Working.” North Carolina Medical Journal, vol. 81, no. 6, Nov. 2020, pp. 364–69. www.ncmedicaljournal.com, doi:10.18043/ncm.81.6.364.
[5] Godbout, Shannon , et al. Chatham County Community Assessment 2010. Formal, Chatham County Health Department, Chatham Hospital, and Chatham Health Alliance, 2010, pp. 1–266, https://www.chathamhealthalliancenc.org/data-dashboards.
[6] Godbout, Shannon , et al. Chatham County Community Assessment 2014. Formal, Chatham County Health Department, Chatham Hospital, and Chatham Health Alliance, 2014, pp. 1–266, https://www.chathamhealthalliancenc.org/data-dashboards.
[7] Godbout, Shannon , et al. Chatham County Community Assessment 2018. Formal, Chatham County Health Department, Chatham Hospital, and Chatham Health Alliance, 2018, pp. 1–266, https://www.chathamhealthalliancenc.org/data-dashboards.
[8] Chatham County Health Department. Spotlight on Health Disparities in Chatham County 2020. 2020, pp. 1–14, https://www.chathamcountync.gov/home/showpublisheddocument/52233/637370515131170000.