North Carolina’s Republican legislative leaders have some explaining to do regarding Medicaid expansion. They keep saying the state can’t afford it, but others states keep deciding they can.
In the midterm elections, voters in three more states — three red states that voted overwhelmingly for Donald Trump — approved ballot initiatives committing their states to expanding the government health insurance program for low-income people. The addition of Idaho, Nebraska and Utah, means that 36 states and the District of Columbia have moved to expand Medicaid under the Affordable Care Act. Meanwhile, in Kansas, Wisconsin and Maine voters elected governors who favor Medicaid expansion.
In an interview with The Wall Street Journal, Johnathan Schleifer, executive director of the Fairness Project, a group that backed the initiatives, said, “Medicaid expansion ballots represent a tectonic shift in health care across the county. The Republican Party has staked its political future on bashing the ACA for the better part of a decade and voters in some of the reddest states rejected that.”
In North Carolina, voters would almost certainly do the same. A 2017 survey conducted by the University of Maryland’s Program for Public Consultation on behalf of Voice of the People, a nonpartisan advocacy group based in Washington, found that 66 percent of North Carolina respondents support Medicaid expansion. A 2017 Public Policy Polling poll found that 63 percent of voters support expansion, with only 25 percent opposed.
What is North Carolina’s reason for holding fast to the shrinking minority of holdout states? Republicans say they’re wary of taking up the 10 percent state share of expansion and maybe the federal government will later ask the states to give more. But it’s not really about cost. The truth is that it’s more expensive to forgo expansion.
A 2014 report funded by the Cone Health Foundation and Center for Health Policy Research and conducted by The George Washington University estimated that cost. If North Carolina declines to expand Medicaid between 2016 and 2020, the state stands to lose $21 billion in federal funding, the report said. That’s almost equal to the state’s annual budget. North Carolina is now halfway to that massive total of funds forgone. And, to listen to Senate Leader Phil Berger, there’s no doubt the state will reach it.
What’s the real reason North Carolina Republicans won’t expand Medicaid for the state’s poor? Mostly, it’s because the expansion is part of President Obama’s signature legislative achievement, the Affordable Care Act, the law Republicans dubbed “Obamacare.” Our Republican leadership didn’t want to be seen as contributing to the law’s success, even at the expense of hurting their own people. They were committed to its repeal. But the late Sen. John McCain put his thumb down, the repeal failed and the Democrats have regained control of the House.
The ACA is safe for at least the next two years. President Obama has moved on. Maybe Republicans can see that it’s time to let go of their spite, give up on obstruction and expand the program that could provide health care for more than 300,000 low-income North Carolinians. It’s not a hard decision. Expansion won’t only help the working poor, it will boost the economy, support struggling rural hospitals, create tens of thousands of jobs and generate more tax revenue.
Leighton Ku, the lead author on the 2014 Cone Health report, said after the midterm elections that “toxic” politics has blocked expansion in some states, but the experience in states that have expanded keeps showing that the political hostility only hurts the holdouts.
“There’s certainly evidence that expansion has been beneficial to states. We see it in hospitals staying in business and community health centers that can expand,” he said. “There were claims that (expansion) is going to bankrupt the states and that didn’t happen either.”
States both red and blue are saying “yes” to Medicaid expansion. It’s time for North Carolina’s Republican lawmakers to explain why they keep saying “no.”