The newest, weakest Republican claim against expanding Medicaid in NC

State Sen. Jim Perry, a Republican from Lenoir County, was appointed to his seat only in January after Sen. Louis Pate resigned because of ill health, but the freshman senator has quickly taken on his party’s most daunting challenge — trying to make the Republicans’ irrational opposition to Medicaid expansion sound reasonable.

Perry gets credit for making a new argument. Unfortunately, it’s also the weakest. In a News & Observer op-ed last week, he said Medicaid expansion would be too much of a good thing. He said that’s because “adding hundreds of thousands of additional people to the Medicaid rolls will only further exacerbate the primary care shortage that already exists in the state.”

In other words, for a half-million of North Carolina’s newly insured working poor, there would be no room at the inn. Or rather, the doctor’s office. The only reasonable course, presumably, is to leave those people uninsured while the Republicans continue to do nothing to ease the primary care shortage.

For support Perry tried some rhetorical jujutsu. He cited a researcher who has explained to the legislature why Medicaid expansion would greatly benefit North Carolina. Perry noted that Dr. Leighton Ku, a professor and director of the Center for Health Policy Research at The George Washington University, speculated in a 2011 article — three years before the Affordable Care Act took effect — that expanding Medicaid would “create surging demand” that “could affect access to care not only for newly eligible beneficiaries but also for others who depend on a state’s existing supply of clinicians.”

But now, with five years of data on what actually happened in expansion states, Ku says his worry did not materialize. He said last week, “Studies repeatedly show that Medicaid expansion increased insurance coverage and improved access to care.”

Perry closes his piece by saying expansion’s backers are misleading the public: “It is disingenuous to only focus on the positive aspects of expansion while ignoring the very real risks.”

That would be true if there were “very real risks,” but what are they? The 36 expansion states seem happy with their choice.

Perry’s argument follows a series of hollow Republican warnings about Medicaid expansion.

First there was the rationale offered by then-Gov. Pat McCrory. He deemed North Carolina’s Medicaid program “broken” and said it would be irresponsible to add a half-million more people to the program. It turned out that the program is actually quite efficient compared to other states and has even come in under budget in recent years.

Next came the claim that the state couldn’t afford its 10 percent share of the cost of expansion. But under Gov. Roy Cooper’s budget proposal the state’s share would be covered by the hospitals and health care plans that would benefit from the surge in insured patients.

Finally, there’s the semi-conspiracy theory that the federal government might renege on its commitment to pay a minimum of 90 percent. Given that 36 states are now getting that level of payment, it’s unlikely that their representatives in Congress would approve cutting it back.

As GOP lawmakers gird the state against a hypothetical Medicaid cutback, real money is flowing away. North Carolina has missed out on billions of federal Medicaid dollars that would have helped struggling rural hospitals, generated jobs and strengthened the state’s economy.

The Republicans are out of excuses. It’s time to expand Medicaid.