DURHAM, N.C. — Memorial vigils were held across North Carolina last week to honor people who have suffered or died because they lacked health insurance. Creston resident Richard Horodyski said until last year, he hadn't seen a doctor in more than two decades.

Horodyski has worked in construction and owns a small fruit farm. He and his wife are long-time foster parents. He said many foster parents are caring for children with special needs, while not being able to see a doctor themselves.

"It's a stressful thing, especially when you're working with kids with developmental disabilities. That was who we specialized in,” Horodyski said. “After awhile, we realized that a lot of the children we were getting had fetal alcohol syndrome, so we kind of specialized in that. It was really, really hard."

North Carolina is one of 14 states that have chosen not to accept federal dollars for Medicaid expansion. It's estimated that nearly a half million people, mostly uninsured adults, would become eligible for coverage if the state chose to expand the program.

As of 2015, North Carolina had more than 10,000 children in foster care, and the state is struggling to recruit foster parents. There is little data available on the number of foster parents who lack health coverage, but Horodyski thinks having health insurance might make more people inclined to take on the responsibility of raising children.

"You can go county by county and see the demand. They are begging for foster parents and they're trying to do trainings to focus on pulling foster parents into the system,” he said.

An estimated 11% of North Carolinians are uninsured, according to the Henry J. Kaiser Family Foundation. Among adults ages 19-64, an estimated 16% are uninsured.

GREENSBORO, N.C. - Local health departments that rely heavily on Advanced Practice Registered Nurses say the costly contract requirement that they be supervised by a physician are draining already scarce resources and affecting North Carolina's most vulnerable populations.

By law, APRNs must must work under doctor supervision, have a collaborative practice agreement, and meet once every six months with their supervising physician.

Health Director at Guilford County Public Health Department Dr. Iulia Vann said her large APRN staff spans the fields of maternal health, primary care, family planning, and HIV and Sexually Transmitted Disease prevention and care.

"And all of these team members, they have to have a supervising physician," said Vann, "based on the requirements from the Board of Nursing in order for them to stay licensed and certified."

The SAVE Act, introduced in North Carolina this year, would remove supervision requirements statewide. But physician groups like the American Medical Association maintain patients are better served by an integrated care team led by a physician.

Vann noted her department shells out tens of thousands of dollars for supervision contracts.

"Our role in the community, and our services for the community are really nurse-driven," said Vann. "And we do not have the resources to include some of these collaborations all the time."

At the Craven County Public Health Department, Health Director Scott Harrelson said physician oversight costs his department around $91,000 a year. He explained that they rely mostly on primary-care physicians to help keep contract costs low.

"They can go from pediatrics and adult primary care, so you could see some maybe potential savings of just doing one contract for the whole shebang," said Harrelson, "especially if you're a smaller health department that doesn't have a whole lot of volume coming through on your primary care."

One 2018 study of rural health clinics in the Southeast found loosening supervision requirements for nurse practitioners improves the numbers of providers, healthcare access and quality of care in rural regions.

CONCORD, N.H. - New Hampshire advocates for affordable healthcare access want Congress to lower prescription costs by allowing Medicare to negotiate with drug companies.

Drug prices have risen faster than any other facet of medicine, and Laura Lynch - a 62-year-old New Hampshire resident who's covered by Medicare and Social Security Disability Insurance - said she spends $300 to $350 a month just on co-pays for medications for herself and her husband.

They're also receiving collection notices, because Lynch said they can't afford the ambulance bills from a heart attack her husband had in February.

"This is ridiculously hard," said Lynch. "Sometimes I just want to cry, because I don't know where it's going to come from, the next penny or dollar to pay these bills. I am so for 'Medicare for All.' But I'm also so for them fixing Medicare, so that situations like this don't come up and we lose everything."

President Joe Biden's budget plan includes improvements to Medicare, such as allowing negotiations with drug companies. Lynch adds for her and many others, it's urgent that Congress take action.

Today is the 56th anniversary of Medicare and Medicaid, which together provide health coverage to more than 120 million people.

Zandra Rice Hawkins, executive director of the group Granite State Progress, said drug companies have a monopoly to set their own prices. She noted other government programs already negotiate with drug companies, and sometimes pay half of what Medicare pays for medicines.

She said allowing Medicare to negotiate would make prescriptions much for affordable for all consumers.

"Lawmakers have not taken meaningful action over the last decade to rein in drug corporations power to price gouge," she said, "despite strong support for policies like Medicare negotiations among all voters of all political persuasions."

The White House plan also would close the Medicaid coverage gap - New Hampshire has expanded its Medicaid program, but in the dozen states that have not, more than two million people don't fit the eligibility requirements, but also can't afford employer-based or marketplace health insurance.

LANSING, Mich. -- Advocates for home- and community-based services in Michigan urged Congress to build off state efforts and invest in what's become known as the "care economy."

President Joe Biden's American Jobs Plan includes $400 billion to expand access to Medicaid home- and community-based services for seniors and people with disabilities, and to strengthen the care workforce.

Kelly Garrett, Michigan state director for Care in Action, said making investments will help keep people in their homes and communities for longer than they would be otherwise.

"We need to pay our essential workers, our domestic workers, our care workers a livable wage," Garrett asserted. "Also, people that need care should be able to get cared for in place in their homes, or wherever they choose to be cared for."

Michigan's paid medical-leave law went into effect in 2019, and applies to any employer with more than 50 workers, but domestic workers often do not fit the criteria.

Garrett joined a roundtable with people who rely on home-based and community services, caregiver advocates and lawmakers. She argued more progress is needed, and the White House plan would support well-paying caregiver jobs with benefits and collective bargaining rights.

Women, and especially Black, brown and Indigenous women, are more likely to leave the workforce to care for a family member, which became all the more evident during the pandemic.

Garrett added care infrastructure, such as home and community-based services as well as child care and paid family and medical leave, are so important because everyone needs care at some point in their lives.

"Everyone's gonna have this situation," Garrett explained. "Either you're going to be the caregiver, or you're going to need to be cared for. It just happens. And so passing this bill allows people to age with dignity, and to be taken care of with dignity."

Home- and community-based services can look different for different people, ranging from meal services and transportation to doctors' appointments, or having a personal aide come in to help get ready for the day and manage their medicines, or speech or occupational therapy at home or at a community facility.

Garrett urged Michiganders to contact their lawmakers and let them know how urgently needed the legislation is.