Denying Medicaid expansion is foolish, and downright mean

May 24, 2014 

Now, Indiana appears ready to accept the Medicaid expansion deal for states under the Affordable Care Act, or at least some form of it. That part of the ACA allows states to expand Medicaid coverage for those low-income people earning up to 138 percent of the poverty level.

Indiana’s Republican Gov. Mike Pence, who prefers the state’s own plan for coverage, nevertheless is recognizing the need to expand coverage even as he still criticizes the ACA. He has come up with a way to use federal support.

Would that North Carolina’s Republican leaders could put aside their hatred of President Obama and all his policies long enough to help the people of their own state, either with direct help for Medicaid or another plan. Under the ACA, states could expand Medicaid with the additional costs paid entirely by the federal government for three years, with the feds paying 90 percent thereafter.

Some 500,000 people in North Carolina might be eligible. That’s half a million North Carolinians who today may be sick, even dying if they don’t get care, who could be covered under Medicaid.

Republicans have few reasons, and no reasons good enough, for denying that care to their fellow citizens. They claim the state’s Medicaid system is broken; there have been problems, but those problems hardly justify denying care to those in need. And if Gov. Pat McCrory were going to live up to the promises of candidate Pat McCrory, then why isn’t Medicaid now just dandy?

Though the state cleared a backlog of Medicaid applications at one point, it’s behind again, with over 90,000 people with applications pending. In Wake County, 12,000 applications are overdue. Problems with NC FAST, the program designed to process Medicaid, have been considerable given staff shortages, technology glitches and changes in laws.

No one factor is to blame, but the seemingly constant upheaval in the state Department of Health and Human Services hasn’t built public confidence in the ability of officialdom to look out for people in need.

Another oft-cited reason for kicking so many citizens to the curb with Medicaid is that even though the federal government says it will pay 90 percent of the cost after three years, it might not. That’s straight out of the zany, tea party handbook: The federal government, and particularly President Obama, can’t be trusted.

But there’s a broader reason, of course. Republicans who now control the General Assembly are opposed to anything from the Obama White House. They even tried early on after taking control to pull North Carolina out of the Affordable Care Act. And when the ACA was affirmed by the U.S. Supreme Court, it was a sad day for them.

The court gave them one glimmer of partisan hope, ruling that individual states could opt out of Medicaid expansion. So that’s exactly what McCrory and his mates did, joining a number of states that passed on the expansion, although more have decided to join as time has passed. Most of those who passed are in Southern states where lower-income people could use the help, but they are under the governance of Republicans who show little interest in helping the disadvantaged.

In the case of North Carolina, turning down a free expansion was all part of a general war on the poor, which also included cutting unemployment benefits and denying many thousands of North Carolinians the chance to receive extended help through the federal government. Again, that would have been paid for entirely by the feds. But Republicans, nonsensically, argued that kicking people off unemployment would force them to look for work, even though that’s exactly what the vast majority of them have been doing.

It may be a point of pride for Republicans in North Carolina to boast when they’re with Republicans from other Southern states that they’ve put their boots on the necks of the poor and unemployed. But outside of that fraternity, their denial of Medicaid to people who need it is in fact a disgrace. And that the expansion would come at no cost to North Carolina and would boost the state economy makes it horribly bad governing.

It’s not too late for McCrory to show gumption, independence, leadership. Sadly, he’s either been absent on controversial issues or simply dismissed by GOP legislative leaders who ignore him.

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