It’s getting lonely out there.

“There’’ is where states are opting to participate in Medicaid expansion.

Simply put, Medicaid expansion was a centerpiece of the Patient Protection and Affordable Care Act, aka “Obamacare,’’ passed into law in 2010. Eligibility for Medicaid was offered to families with an annual income below 138 percent of the poverty level. The measure was challenged in court but upheld by the Supreme Court in 2012. However, that ruling gave states a choice of opting out of Medicaid expansion.

A lot did. Since then, a lot have changed their mind. Currently, 38 states and the District of Columbia have opted for expansion. The number who have not is constantly dwindling.

Inexplicably, North Carolina remains one of the holdouts.

Such has been the case for years. The case for expansion is far stronger than the case against, which is mainly based of vague fears as to what the future may hold.

The foundation for expansion has the federal government picking up 90 percent of the costs. Expansion would give access to health care to around 650,000 North Carolinians.

A 2019 study by Cone Health, the Kate B. Reynolds Charitable Trust, and the Milken Institute School of Public Health showed 3,299 more Jackson County residents would immediately be able to seek medical care under expansion.

And with the COVID-19 relief measure working its way through Congress, the case for expansion gets even stronger.

Essentially, the federal government has offered a carrot to states in an effort to get them to expand.

Under the new bill, the carrot just got a lot bigger.

It caps ACA coverage at 8.5 percent of an enrollee’s income, down from the 9.8 percent cap for those making up to 400 percent of the poverty level. It raises subsidies, meaning those earning less than 400 percent would spend less. Those who lose their jobs would receive additional help to stay on their insurance.

Perhaps most importantly, it would bump North Carolina’s federal share of Medicaid expansion, and non-expansion Medicaid spending, 5 percent. That would mean an extra $2.4 billion for the state, according to an analysis from the Center for Budget and Policy Priorities.

Robin Rudowitz, the Kaiser Family Foundation’s Program on Medicaid co-director, said “Even though states still pay 10 percent (for the new patients), they would still come out ahead. I think that changes the math.”

In many important ways, the math has already changed, and not for the better. The pandemic has cost thousands of North Carolinians their livelihoods and their medical coverage. It’s nowhere near over. Many of those who have managed to hang on to their jobs or small businesses are barely hanging on.

Billions of federal dollars are readily available to help them. Even if the new bill falters in Congress, the old deal still makes sense.

All the General Assembly has to do is say “yes.’’

North Carolina doesn’t have to be lonely anymore.