With ACA affirmed, NC should move to expand Medicaid

It was a potential catastrophe for over 6 million Americans, including more than 400,000 in North Carolina, who receive subsidies to buy health insurance. A challenge to the part of the Affordable Care Act that allowed people to get those subsidies through federal exchanges if their states didn’t set up an exchange of their own could have ended subsidies for people in 34 states and resulted in millions suddenly not having health insurance.

Thankfully, on Thursday, a U.S. Supreme Court ruling affirmed the right of people to have those subsidies. The ACA survived another challenge, though others may linger, even though Republicans on the national level have backed away from making the ACA a central theme of their political strategy against President Obama.

An exception is U.S. Sen. Thom Tillis of North Carolina, who said after the ruling that he’d continue to seek repeal of a law that has helped millions of Americans buy health insurance and doubtless saved lives. That’s not good enough for Tillis, who he has no alternative of his own but said, “Regardless of the Supreme Court’s ruling today, the president’s health care law is beyond repair and I remain committed to finding and implementing a solution.”

That’s a preposterous statement, of course. The ACA, after a stumbling start, has worked, and its success, a signature of President Obama’s administration along with the economic comeback following the Great Recession, is driving Republicans up the wall. In the ACA’s first year, the rate of uninsured in North Carolina dropped 13 percent. How is that “beyond repair”?

Tillis makes himself look foolish with groundless statements such as this one.

Chief Justice John Roberts, for the second time, sided with the Obama administration in upholding the ACA and writing that the high court should not overturn the will of the people as expressed by the legislative branch of government.

The ACA has been criticized with some credibility as poorly written in spots, and certainly technical difficulties when it rolled out didn’t help. But conservative critics have offered only scathing reviews of the ACA without putting forward a sound alternative that would have helped people, that would have treated health care more as a right, as it is in other industrialized countries around the world, instead of a commodity.

The truth is, relief over the reaffirmation of the legality of the ACA and its provisions isn’t resulting simply in easier breathing from Democrats. The Republican governors in those states where people got their insurance through a federal exchange are as relieved as anyone.

For they, as well as individuals, were facing chaos had the high court ruled against the administration. In each of those states, tens of thousands if not hundreds of thousands of people would have been left without health insurance, absent subsidies. That would have meant economic disaster for families if a catastrophic illness struck; it would have meant people with medical conditions who relied on the subsidies to get coverage would have been out in the cold again.

The Supreme Court ruling should be an end to challenges to the ACA, but it probably won’t be. Tillis, after all, went to the Senate after being speaker of the House in North Carolina, where he presided over legislation that ignored the needs of many of the state’s poor and sick. He’s going to remain as indifferent to their needs as he is impervious to facts about the health care law.

Meanwhile, Gov. Pat McCrory has shown a lack of political courage in declining to support an expansion of Medicaid, the state and federal insurance program for the poor and disabled. The federal government, under the Affordable Care Act, would pay 100 percent of the expense in the first three years and at least 90 percent thereafter. McCrory said he was awaiting the high court decision to make his own decision about pushing for Medicaid expansion. But he wasn’t. Once again, the 500,000 North Carolinians who could be helped are left to hope that a move to expand Medicaid comes before an illness or an accident does.