It is a very steep competition, I’ll concede. But the decision by Gov. Pat McCrory and our General Assembly to reject Medicaid expansion is surely among the worst made by the State of North Carolina in the last quarter-century. Given the decision’s tragic consequence and its potent illogic, a heavy burden falls on our leaders to explain it. That’s not happening.
The governor repeats his talking points like a Hindu mantra: “The Medicaid system is broken.” Then he continues his best efforts, via DHHS Secretary Aldona Wos, to fulfill the prophecy.
Legislators claim the federal government’s statutory commitment to pay 100 percent of the cost until 2017 and then at least 90 percent thereafter might be breached. The position is laughable as we scramble for federal funds on every front. Apparently concern for solvency, or resolution, arises only when it’s necessary to justify turning away billions to provide health care for the poorest Tar Heels. I assume we’ll stay at the trough for transportation bucks.
The trend continued last week in the Hagan-Tillis Senate debate. After a blast of primary ads boasting, “Thom Tillis stopped Medicaid expansion cold, it’s not happening in North Carolina because of Thom,” the challenger went mum. When Norah O’Donnell asked him to justify keeping hundreds of thousands of vulnerable citizens from Medicaid, he replied, all facts to the contrary, “I want the best health care system in the world, and that’s what we already have.” Two million Tar Heels with no coverage of any kind likely disagree.
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National news outlets reported that Tillis again refused to answer questions about Medicaid expansion after the vacuous debate. So much for straight talk.
To briefly review the facts: The federal government has offered to pay almost the entirety of the health care tab for about a half-million impoverished Tar Heels. We’ve said no thanks. We don’t like the donor. The Urban Institute reports that will cost us $40 billion over the next decade. N.C. hospitals will lose $11.3 billion. Thousands of jobs will disappear. Closures resulting from the hideous decision have already begun.
A massive McClatchy study revealed that North Carolina taxpayers will spend over $10 billion to provide medical care for the low-income residents of other states – states less interested in proving how much they detest their poor people. Duke professor Don Taylor has shown the move to be a “redistribution of money from poorer states to richer ones, imposed by the poorer states upon themselves.” As Southern as pimento cheese.
But these figures, these data-laced economic arguments, point up one of the harshest features of modern American politics. This is what we do to try to affect policymakers. We explain that the economy will pale, the businesses will contract, the talented will flee, our manly efforts to outpace other states will be diminished. The wind will weaken in our sails.
But we largely avoid the more crucial point. The consequences for poor people of being excluded from health care coverage are real and dramatic. Losses in health, losses in emotional well-being, losses in financial capacity, losses in opportunity. And, for some, it’s worse.
A recent Harvard study indicates a significant number of our sisters and brothers will experience premature and preventable deaths as a result of the General Assembly’s rejection of Medicaid expansion. Many “low-income women will forgo breast and cervical cancer screenings, diabetics will (fail to receive) necessary medications,” blood pressure pills and other preventative measures will be denied, “diagnosis and treatment of depression” will be diminished.
As a result, the scholars estimate, the number of Tar Heels who will perish at the hand of our politics may well exceed a thousand a year. The wound inflicted by the Medicaid vote is grievous, deep and sometimes mortal.
I’ve wondered how it feels to cast a vote that means thousands might needlessly die. I can’t get my arms around it. Looking in the mirror must become tougher duty. I can see not wanting to dwell on it.
But when you make a decision that means people may lose their lives, surely you have to do more than offer empty slogans and nonsense-laden talking points to defend it. Surely you have to show you’ve done something more than merely taken instruction, more than mindlessly repeated what you’ve been told – like some malfunctioning teleprompter.
At least you ought to show that you’ve thought it through for yourself. That you’re not just siding with one gang or the other or proving your antipathy for various adversaries.
When politics becomes lethal, responsibility ascends.
Gene Nichol is Boyd Tinsley distinguished professor at the UNC School of Law. He doesn’t speak for UNC.