End our NC tragedy of needless deaths. Expand Medicaid.

When it comes to health care for low income citizens, North Carolina has, since 2012, been a lead participant in a tragic ideological experiment. By rejecting the Medicaid expansion offered as part of the Affordable Care Act, our General Assembly refused to allow roughly a half-million poor Tar Heels to receive health care coverage paid almost entirely by the federal government. The decision has cost us billions of health care dollars, hundreds of millions in tax revenue, tens of thousands of jobs, a number of rural hospitals, and worst of all, thousands of lives.

Many fear that the costly choice was made to demonstrate an unyielding hostility to President Obama. I’m likely among them. But, being more generous, perhaps North Carolina’s decision to send its federal tax dollars to other states represented a longer-term, philosophically-driven plan to fight relentlessly, even at large cost, to slay Obamacare and Medicaid in favor of some undisclosed but imagined totally privatized health care system. If so, the dreamed of non-public nirvana is dead.

Nearly 40 states have accepted Medicaid expansion. In response to ideologically rigid legislatures, citizens have also taken to the initiative to get health care. Lots of red states have signed on. An impressive number have re-upped.

Republicans in Washington refused to kill the ACA or Medicaid last year. Now Democrats control the House. As conservative columnist Jennifer Rubin has written: “Obamacare is here to stay, it’s more popular than ever, and red America has fallen in love with Medicaid expansion.” The question is whether we’ll insist on being the last holdout.

Our health care debate, by now, is more about people than ideology. Medicare, Medicaid, the Veterans Administration, and tax subsidies (all government programs) constitute a huge percentage of our health expenditures. And, still, we leave more in the shadows than any major nation. I spoke recently to Dr. Steve Luking, a family practice physician in Reidsville. He explained:

“For 30 years, I’ve watched my patients with no insurance pay a terrible price. I’ve seen women die of invasive breast cancer and cervical cancer because they couldn’t afford mammograms and preventive checkups. I’ve hospitalized patients who stopped their medicines to pay other bills. I’ve seen the slow death by invasive colon cancer of patients who couldn’t afford a colonoscopy and diabetics who couldn’t pay for insulin. Despite what people say, the emergency room doesn’t provide the care these folks need. When is the last time someone received a pap smear in an emergency room?”

Luking’s words reminded me of an earlier conversation with Dr. Pradeep Arumugham, a heart specialist in Kinston. He spoke of one of his patients who made about $10,000 a year working in a local diner. He treated her initially in the emergency room at Lenoir Memorial. He stabilized her, but her heart remained weak. She was in her early 60s. Her sister died from the same malady.

Arumugham’s patient needed a defibrillator. She couldn’t afford private insurance. She couldn’t get ACA subsidies, ironically, because she was too poor. Arumugham saw her for several months but couldn’t secure the machine. So she died. He explained:

“We could have saved her. I treated her for free, her meds weren’t expensive, but we couldn’t get the device she needed. She’d be alive today if we accepted Medicaid expansion. That’s the simple fact.”

Arumugham’s patient would be alive today if she lived in any of the 36 states accepting Medicaid. She died because she was a Tar Heel.