By Erika Munguia
Access to affordable care is the main factor that drives people to consider alternative medicine. As a result, individuals seek home remedies as a replacement for prescribed medications and rely on religion for divine healing and support. This reality is especially prevalent in rural and marginalized communities. In North Carolina, there are over one million uninsured residents due to the state’s decision not to expand Medicaid upon the introduction of the Affordable Care Act (North Carolina). Understanding the impact of this decision on the health outcomes of people of color and low-to-middle-income individuals is paramount as health disparities and inequalities are exacerbated by lack of health insurance. Through the stories of four Carolinian residents – Albrea Crowder, Ernest Taylor, Stephanie Atkinson, and Crystal DeShazor– this essay explores the ways in which individuals and communities have been directly or indirectly affected by the state’s decision to withhold the expansion of Medicaid and the ways in which this decision prompts the use of alternative medicine.
Background on the Affordable Care Act
Providing context on the health insurance system in the US is critical when addressing the Affordable Care Act (ACA) and the Medicaid expansion. In 1965, the Johnson administration established Medicaid as a joint federal and state program, defining minimum eligibility criteria to include income and assets requirements in vulnerable groups, such as pregnant women, children, and people with disabilities (Spencer). Forty-five years later, the Obama administration introduced the Affordable Care Act with the goal to eliminate racial and ethnic health disparities throughout the US by means of increased provisions of affordable health insurances (Bell and Little). However, in 2012, a Supreme Court ruled that although the 2010 ACA was an expansion of Medicaid eligibility to include most people under the 138% federal poverty level, the decision to expand Medicaid remained exclusively optional for states (Spencer). Hence, this ruling limited the number of individuals that would have benefited from having access to equitable health insurance.
North Carolina is one of the 12 states that did not expand Medicaid – excluding non-disabled childless adults at any income level and leaving nearly 208,000 low-income individuals without access to insurance coverage (Spencer). No political debate can contradict that lacking access to affordable health care only amplifies health disparities as uninsured individuals are more likely to face worse health outcomes due to their limited ability to obtain health insurance coverage. Yet, the US and its states continue to perceive health care as a political policy, neglecting the health of ill and disadvantaged individuals that need access to health insurance.
Most Affected Individuals in NC
North Carolina’s decision to not expand Medicaid negatively impacted the health of the individuals that need insurance the most – especially those who do not necessarily meet the requirements but cannot afford healthcare (Oberlander). Acquiring health insurance through employer-sponsored is nevertheless a challenge for some individuals – specifically people who are just above the federal poverty guidelines, non-pregnant women, and adults below the age of 64 (Spencer).
Albrea Crowder, a participant in the Stories to Save Lives Project, shares that her patient, a CNA whom she has seen for about seven years, comes to their clinic because she doesn’t have health insurance (Crowder, 52.21-54.31). The patient did not qualify for health insurance through Medicaid, so the clinic offered a “slide-scale fee” to help her copay her bills, given NC’s reluctance in expanding Medicaid through the ACA (Crowder, 53. 21). The patient faced a difficult situation in which she had to fight for affordable coverage and received medical care based on financial limitations at the expense of her health. Patients like the CNA worker are less likely to receive preventative care and more susceptible to preventable illnesses.
As alluded to by Crowder, those primarily affected by NC’s decision are people of color and low-to-middle income individuals. In the CNA’s case, having a job and source of income was the reason she was denied public health insurance. The US health insurance systems create gaps and inequities, where the individuals who need insurance – the most – lack access to public health insurance.
Impact on the Health of Racial and Ethnic Minority Communities
The diversity of North Carolina has been recognized as its total state population is estimated to be 25% African American, nearly 10% Hispanic/Latino, and approximately 2% American Indian (Bell and Little). Yet, 27.7% of Hispanics/Latinos and 13.6% of African American adults remain without access to health insurance (Oberlander). The documented struggles faced by minorities highlight that health insurance coverage is the primary source of health disparities and inequality. African American infants are 2.5 times more likely to die during their first year of life; African American and American Indians are approximately 2.5 times more likely to die from diabetes; Hispanics/Latinos are five times more likely and African Americans nearly 10 times more likely to be diagnosed with HIV/AIDS when compared to white counterparts (Bell and Little). While these health disparities can be prevented with early screening and treatment options, most communities lack access to yearly check-ups as African Americans, American Indians, and Hispanics/Latinos are less likely to have insurance due to cost (Bell and Little).
Moreover, North Carolina’s rural population, which is estimated to be the largest in the country, with nearly 2.2 million people – 20 % of whom are racial/ethnic minorities – experience exacerbated health disparities (Bell and Little). The underlying health conditions of the individuals living in rural areas are aggravated by the fact that health care is limited, so it becomes more difficult to find affordable health care than to resort to alternative medicine.
Ernest Taylor, a resident living in Nash-Rocky Mount, a rural county, recounts the many times he has witnessed the impact of lacking affordable health insurance in the African American community. In his interview, when asked about the health issues, diseases, or medical needs in his community, Ernest says “herpes, a lot of people with high blood, diabetics, cholesterol” and “and the lack of health insurance” (Taylor, 30:14). He emphasizes that these diseases are concerning people in the community because “a lot of people don’t have health insurance” (Taylor, 30:14). Hence, most uninsured individuals are not able to obtain annual health check-ups and afford the needed treatment, causing health disparities to increase. He shares similar sentiments as Albrea Crowder and says that:
“If we had health insurance, people’s lives would be much better and it would be a much healthier environment for everybody. A lot of people live in despair. There’s elder people who’s on fixed income, some of them have to make a choice between food and medicine” (Taylor, 30:49-30:56).
Even when uninsured individuals are aware of their serious illnesses, they opt for low-cost treatments that sometimes only aggravate their health conditions. And when economical treatments are limited, individuals adhere to alternative medicine because it is more accessible than health insurance.
Lack of affordable Care Leads to Alternative Medicine Use
Most uninsured individuals cannot afford high copays and insurance deductibles costs, so they turn to home remedies and religion for help. Two African American women, Stephanie Atkinson and Crystal DeShazor comment on how home remedies and religion became replacements for health insurance. In the interview, Atkinson recalls how her parents used a lot of home remedies because they “didn’t go to the doctor” and how her grandam drank honey and mixed “some type of alcohol with a banana peel” as a treatment for her arthritis and leg (Atkinson, 20:08). Her parents chose home remedies over visits to a doctor because they felt that home remedies were more suitable given that they lack health insurance. Similarly, DeShazor shares how “faith was everything to [her],” how it motivated her, and how having health insurance for the first time improved the quality of care she and her daughter received (DeShazor, 38:17 & 16:04). Before working as a health care worker, she worked multiple part-time jobs that did not offer any health insurance plans (DeShazor, 16:10]). When she was sick and lacked access to affordable health care, she sought social support in her church and prayed for her bleeding to stop recalling that it “was the first and that was the last time that it ever happened” (DeSharzor, 39:14). Her spiritual faith strengthened her and minimized the constant worry created by the lack of health insurance. Both Atkinson and DeSharzor relied on alternative medicine when they lacked access to affordable health care, so they sought home remedies and religions as replacement for health insurance.
Understanding the regulations behind the ACA and its relation to affordable health insurance access becomes crucial when recognizing the impact on the health of the state’s populating. After all, it becomes evident why individuals use alternative medicine – as obtaining decent insurance coverage is challenging, especially for low-to-middle income individuals and communities of color living in rural areas. Lack of affordable healthcare negatively affects the health of many North Carolinians as many are unable to keep up with the expensive insurance deductibles and treatments.
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Crowder, Albrea. Interview with Maddy Kameny. Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill. 15 June 2018 (Y-001). https://dc.lib.unc.edu/cdm/ref/collection/sohp/id/27951.
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North Carolina: The New Frontier For Health Care Transformation | Health Affairs Blog. https://www.healthaffairs.org/do/10.1377/hblog20190206.576299/full/.
Oberlander, Jonathan. “Unfinished Journey: The Struggle over Universal Health Insurance in the United States.” The Social Medicine Reader, Volume II, Third Edition, Duke University Press, 2019, pp. 305–13. www.degruyter.com, https://www.degruyter.com/document/doi/10.1515/9781478004363-034/html.
Spencer, Jennifer C., et al. “Health Status and Access to Care for the North Carolina Medicaid Gap Population.” North Carolina Medical Journal, vol. 80, no. 5, Oct. 2019, pp. 269–75. PubMed, doi:10.18043/ncm.80.5.269.
Taylor, Ernest. Interview with Lauren Grey. Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill. 25 June 2019 (Y-0130). https://dc.lib.unc.edu/cdm/compoundobject/collection/sohp/id/28512/rec/91.