Over the past several years, arguments for Medicaid expansion in North Carolina have been made using sound economic, budgetary and public health rationales. They have collapsed, however, under the reflexive antipathy toward the Affordable Care Act of Gov. Pat McCrory and conservatives in the state legislature.
The result: Tens of thousands North Carolina’s workers go without health insurance compared with states that expanded Medicaid, according to a study by Families USA. Expansion states, on average, saw a 25 percent decline in their rate of uninsured workers, compared with just 15 percent for North Carolina – a difference of nearly 2 to 1.
It shouldn’t be this way. State-federal partnerships, like Medicaid expansion, have a history of success and have been a hallmark of Republican governance for more than a century.
Start with the Land Grant College Act of 1862, sponsored by Congressman Justin Morrill – a founder of the Republican Party – and signed by Republican President Abraham Lincoln.
Under the act, the federal government gave states federal land they could manage or sell to endow colleges specializing in agriculture and engineering. The states would pay for the construction and maintenance of the schools.
Since 1862, more than 20 million people – many who could not have otherwise afforded it – have graduated from the 100 land grant colleges were created in every state and territory.
The list of alumni of North Carolina’s two land grant institutions – N.C. State University and N.C. A&T State University – is a “who’s who” of accomplished men and women: governors, U.S. senators and representatives, judges, generals, business and civic leaders, scientists, writers, artists, musicians and athletes – from Apple COO Jeff Williams to NASA astronaut/scientist Ron McNair, who died in the space shuttle Challenger disaster.
Not a bad return on investment for a law enacted when the outcome of the Civil War was still very much in doubt.
Another example is the Federal Highway Act of 1956, proposed by Republican President Dwight Eisenhower, who as Supreme Commander of European Forces in World War II had seen first-hand how deficient America’s road network was compared to the German Autobahn.
As president, Eisenhower decided the United States needed a national network of modern roads and that it had to be a joint state/federal enterprise. Otherwise our nation “would be a mere alliance of many separate parts,” he said.
The bipartisan bill Eisenhower signed called for the construction of more than 46,000 miles of interstate – 1,296 in North Carolina – that would be paid for with a 90-10 split between the federal government and states respectively.
Studies have shown that every $1 invested in the interstate system returned $6 in economic benefits.
Medicaid expansion is in the best tradition of these historic state-federal partnerships. Helping low-income North Carolina get health care is an investment in human capital every bit as important to our future as building universities and roads.
In North Carolina, Medicaid is very restrictive. Parents of dependent children cannot receive coverage if their incomes exceed a meager 44 percent of the federal poverty level, approximately $739 a month for a family of three. Other adults – singles and childless couples – can’t get coverage even if they have no income at all.
Medicaid expansion would extend eligibility to adults with incomes at or below 138 percent of the federal poverty level – or about $2,130 a month for a family of three.
The majority of the expansion population – estimated at up to 500,000 in North Carolina – are working men and women who earn too much to qualify for traditional Medicaid but not enough to be eligible for subsidies on the health care exchange.
The federal government would pay 95 percent of the cost in 2017, sliding to a permanent 90-10 ratio by 2020 – the precise split of the Highway Act.
The North Carolina legislature should revisit Medicaid expansion during this year’s session with a vision that extends beyond short-term election cycles, but rather looks out toward the horizon and generations yet to come – as great Republican leaders like Lincoln and Eisenhower did.
Ron Pollack is executive director of Families USA, the national organization for health care consumers.