Expand NC Medicaid before Congress changes or repeals the ACA

Gov. Roy Cooper’s move to expand Medicaid may not go through, but it has accomplished this: It has exposed the financial recklessness and callousness of North Carolina’s Republican leadership.

Republican legislative leaders, members of Congress and conservative advocacy groups have moved in lockstep to oppose Cooper’s sensible and compassionate proposal. That unified opposition confirms that the party’s leadership is driven by nothing more than a blind desire to oppose President Obama’s signature health care program, logic and the health of North Carolinians be damned.

Senate leader Phil Berger, R-Rockingham, and House Speaker Tim Moore, R-Cleveland, have sued to block Cooper’s effort to expand Medicaid to as many at 500,000 low-income North Carolinians. In a joint statement, they called Medicaid a “welfare entitlement program.” A federal judge has reserved Friday for a hearing on the issue.

Cooper noted the wrongheadedness of that opposition. He said, “North Carolina will miss out on more jobs and better health care without Medicaid expansion. It’s frustrating and disappointing that we’re having to fight our own legislature in court to get it done.”

Toll of resisting

The Republican leaders may succeed in this last chapter of anti-Obama obstruction, but they will not be forgiven. The opposition to Medicaid expansion has allowed the preventable deaths of low-income North Carolinians. Doctors point to patients who suffered heart attacks because they couldn’t afford a pacemaker, or a scan that would have detected cancer before it became fatal.

At the same time, this neglect is costing the state billions of dollars in lost federal aid and tens of thousands of jobs that would have come with that funding.

Cooper, to his great credit as a governor and human being, is trying to end run the legislature’s obstruction by applying directly to the federal government for an expansion of the program.

The reasons to expand are overwhelming. Federal funds would cover 95 percent of the cost through 2019 and no less than 90 percent thereafter. The state would receive billions of dollars in health care funds and hospitals would face less care for indigent patients. Thirty one states and the District of Columbia have expanded. Nineteen states, mostly in the South, have said no. North Carolina now stands in that shrinking and obstinate crowd.

Holdouts could be left out

Now, with Republicans in full control in Washington and determined to repeal the Affordable Care Act, North Carolina’s resistance could become even more costly. Sixteen states that have expanded Medicaid are led by Republican governors. Most of them are appealing to Congress to continue the extra federal funding for Medicaid under the new GOP plan. But states that did not expand will have no increased funding to preserve.

Mark Hall, director of the Health Law and Policy Program at Wake Forest University, says the smart move for North Carolina would be to expand now. “We would be at a disadvantage if we do not expand because the non-expansion states may not be treated as generously by whatever replaces the Affordable Care Act,” Hall says.

North Carolina’s Republican leaders defend their continuing opposition as fiscal prudence. They say the state can’t afford to participate in an expansion because the cost could balloon in later years. There’s no evidence in the past to think that will happen. And, Hall notes, the increased economic activity generated by expansion would generate more than enough new tax revenue to cover the state’s share of the cost.

The legislative leaders’ claims of holding down costs are especially hollow against their own record. This is the legislature that gave us HB2, a needless blow to the state economy that has cost the state at least $395 million in lost revenue and an untold amount in damage to its reputation.

North Carolina’s Republican leadership has a miserable record of spending or saving in ways that help the state. They could improve that record by following Cooper’s lead of expansion and putting North Carolina in a stronger position as Congress repeals or changes the Affordable Care Act.

This story was originally published January 21, 2017 at 2:41 PM with the headline "Expand NC Medicaid before Congress changes or repeals the ACA."