Last year was a great one for the once uninsured. Record numbers of individuals and families purchased insurance through the Affordable Healthcare Act in 2023. Here in North Carolina, we became the 41st state to expand Medicaid; 600,000 adults previously priced out of the health insurance marketplace will now have access to networks of providers offering comprehensive primary and preventive health care.

This issue of the journal lays out the ambitious plans to make it easier for people in our state to participate in caring for their own health. It is a primer, borrowing from other states that successfully expanded Medicaid, while also sharing innovative ways to ensure that health care is not only affordable but accessible, acceptable, accountable, and of the highest quality.

More than celebrating Medicaid expansion, this issue also reminds us that health care is a matter of public policy. North Carolina is concerned with who has access to prevention and treatment, but also who receives interventions that promote health. We are reminded, again, that our health is intimately connected to social drivers—income, equity, food, housing, and well-being—that occur outside of the walls of clinics, emergency departments, and hospitals.

Our legislators and public servants have been mindfully remaking the landscape of public health care since well before debating and voting to expand Medicaid. Patients and providers alike are align­ing with networks of care that incentivize both health outputs—who and where we receive care—and outcomes, such as whether the care we receive keeps us healthy. Though expansion has been a long time coming, this issue reminds us that long ago we made Medicaid more accessible to children and pregnant women, using public policy to improve access to assessments, screenings, and referrals that address early childhood physical and mental health, planned pregnancies, and additional supports. Through many flexibilities and continuous coverage, we ensured that more people had access to care during the COVID-19 pandemic. This was not without confusion or struggle, at times, but the impact has been clear. Now those responsible for the health of our state are implementing best practices for removing further barriers to enrollment.

Read, and appreciate, that children with behavioral health needs are identified and treated sooner. Read, and appreciate, that persons with more severe mental illness or intellectual disabilities are on the cusp of receiving wrap-around care to improve their quality of life. Read, and appreciate, that children engaged with social services, protective services, and foster care will receive the attention they need to overcome adverse childhood experiences through nurturing resilience.

We didn’t just expand Medicaid in North Carolina. We expanded life-enhancing opportunities.