Obamacare turns 10 today. Amid the coronavirus pandemic, fights over its future still rage in NC
Obamacare, or the Affordable Care Act, became law 10 years ago today. And now in the midst of the coronavirus pandemic, its provisions expanding health care access are under an increasingly bright spotlight.
At the federal level, Republican President Donald Trump wants to get rid of it. His administration has joined with some Republican-led states in a lawsuit aimed at dismantling Obamacare. That lawsuit came after Republicans in Congress failed to repeal the law early in Trump’s presidency, despite controlling both the House of Representatives and the Senate.
Trump said at a press conference Sunday that the growing crisis surrounding COVID-19, the disease caused by coronavirus, hasn’t changed his mind about the lawsuit targeting Obamacare.
N.C. Attorney General Josh Stein, a Democrat, previously joined other Democratic state attorneys general to fight Trump’s attempt to dismantle Obamacare in the courts. And after Trump said Sunday that he plans to continue with his lawsuit against Obamacare, Stein wrote on Twitter that the middle of a pandemic is not the right time to take away peoples’ health care coverage.
More than 20 million additional Americans have gotten health insurance since Obamacare became law in 2010, according to 2018 data from the Trump administration’s National Center for Health Statistics.
“Now more than ever access to health care is critical,” Stein wrote Monday. “That’s why my Democratic AG colleagues and I are in the US Supreme Court fighting to keep the Trump Administration from eliminating it.”
Trump has said he thinks he could come up with a better health care plan of his own. However, with his first term nearly over, no such replacement plan has ever materialized. And earlier this year, Trump’s Secretary of Health and Human Services Alex Azar said “there’s really not a need” for a plan to replace Obamacare, according to political journalism website The Hill.
But while the national fight over the fate of the entire Affordable Care Act goes on — The U.S. Supreme Court is could hear arguments later this year, Politico reported — there is also a state-level battle that has been going on for years here in North Carolina.
Expand Medicaid in NC?
While Obamacare expanded health care coverage to a certain baseline, it also gave states the opportunity to expand coverage further through Medicaid funding. Most states have done so, although a few holdouts — mostly in the South and the West — have not.
It hasn’t always been a political fight. Many Republican-led states have expanded Medicaid under Obamacare, Kaiser Health News reported. Indiana even did so while Trump’s vice president, Mike Pence, was the state’s governor.
But in North Carolina, the fight over Medicaid expansion has been highly political.
Democratic Gov. Roy Cooper made it a key part of his 2016 election campaign and has continued pressing for it, to no avail. But many Republican lawmakers oppose the idea. And since Cooper can’t expand Medicaid by himself — that’s up to the legislature — there has been no expansion.
Rep. Marcia Morey, a Durham Democrat, said Monday that expanding Medicaid should be a key part of the state’s response. She wrote a Twitter thread with numerous ideas for addressing coronavirus, ranging from Medicaid expansion to releasing elderly prisoners, increasing unemployment benefits and paying businesses incentives to make more medical supplies.
“Expand Medicaid to allow for 600,000 North Carolinians who might get sick to get health care,” Morey wrote.
However, that appears unlikely. The political battle over Medicaid expansion is a large part of why North Carolina isn’t operating under a new state budget. Cooper vetoed the budget in part because it didn’t contain a Medicaid expansion. Lawmakers didn’t attempt to negotiate any changes, and lacked the votes in the Senate to override the veto.
As the legislature prepares new bills to address the coronavirus pandemic, there are several new task forces that will address different angles, like the economy, or schools. The health care task force is co-chaired by a top GOP budget writer and retired hospital CEO, Rep. Donny Lambeth of Forsyth County.
Lambeth is also one of the legislature’s most vocal Republican advocates for Medicaid expansion. In both 2017 and 2019 he was a main sponsor of expansion bills that gained broad bipartisan support in the N.C. House of Representatives but failed due to GOP opposition in the N.C. Senate.
In a lengthy interview last week, Lambeth never mentioned Medicaid expansion as something to consider. Once the task force starts meeting this week, he said, his top priority is increasing access to telemedicine — where someone can make a video call to their doctor and potentially be diagnosed, to save them from having to come for an in-person visit.
He also said the legislature needs to figure out a way to make sure hospitals can maintain their staffing levels of nurses and doctors, even with schools closed. Other top priorities include increasing the number of tests, ventilators and beds available for people who do need to be hospitalized.
“People are having issues with testing, with access, worries about ventilator machines,” Lambeth said. “All these things you see out there in the media ... we will try to bring some organization to those discussions in the next few days.”
However, Lambeth did say that Congress is considering emergency changes to the funding formula for Medicaid — which is separate from the expansion discussion.
Right now, for regular Medicaid costs in each state, the state pays around 33% and the federal government pays around 67%. But Lambeth said if Congress were to pick up an extra 6% of the cost, as some have suggested in Washington, D.C., that would free up hundreds of millions of dollars for North Carolina to redirect to other needs.
“That could be $700, $800 million coming to North Carolina,” Lambeth said. “That would be huge.”
