Must-have Medicaid expansion in North Carolina

Republican opposition to the Affordable Care Act and Medicaid expansion has become a prolonged and frightening attack on the working poor, job creation and the health of the hospital system in North Carolina.

Gov. Pat McCrory and the leaders of the General Assembly took a sworn oath to uphold the Constitution and the laws of the United States. The ACA was duly passed by Congress to provide health insurance to lower income citizens. The law is working as more than 10 million Americans have gained coverage. However, Republicans ignore the success of Obamacare and continually violate their oaths of office requiring them to follow the law. Instead of working to improve the ACA, Republicans strain to sabotage health care coverage for thousands of lower income citizens.

North Carolina could have created 25,000 more jobs with Medicaid expansion. Over 400,000 of us still have no health care insurance. We turn to the emergency room for costly, inefficient care. Hospitals are denied billions of dollars of available federal aid for indigent care because of Republican inaction. Large sums of our federal tax dollars are lost forever as they flow to more progressive states.

Republican opposition to Obamacare is particularly petty and partisan because it flies in the face of the law’s history. The ACA is largely a Republican creation. The simple facts are these: The law is broadly modeled on the extensive health insurance expansion enacted a decade ago by then-Gov. Mitt Romney in Massachusetts. His advisers later gave important counsel to both the Senate and the White House as the ACA was developed.

Obamacare is largely dependent on private sector insurance companies, not a single-payer government entity. This approach clearly tracks proposals made by various Republican think tanks in response to the single-payer model suggested by Hillary Clinton in the early 1990s. Obamacare clearly embodies Republican free market philosophy, and it was carefully crafted in close consultation with GOP members of the Senate Finance Committee and their allies – the hordes of insurance company lobbyists.

President Obama actually deserves little credit for the conceptual framework of the law. However, he courageously insisted that Congress draft health care reform and then he threw the full weight of his presidency behind the initiative. The GOP quickly abandoned the legislation soon after it was drafted. Republicans then pivoted diabolically to attack health care reform and almost everything else proposed by Obama.

McCrory and the General Assembly should implement Medicaid expansion now. Expansion should become part and parcel of McCrory’s so-called Medicaid reform. Three years of legislative wrangling should end with both phased-in reforms and incremental Medicaid expansion for the working poor. The White House has consistently signaled Republican-controlled states that it will offer administrative flexibility to implement expansion quickly. The General Assembly should choose the administrative model advanced by McCrory and the House. A doctor-managed system holds much more promise than anything proposed by insurance companies, especially those from out of state.

The long lens of history may eventually recognize that Obamacare is mostly a Republican idea or at least an effective bipartisan initiative. We are a progressive, moderate state. It is time for the Republicans to honor and reflect that tradition. It is also time for them to remember that it is their sworn constitutional duty to uphold the law even when they don’t agree with it.

McCrory and the General Assembly need to protect the working poor, stimulate job growth and help our struggling hospital system.

William C. Crawford of Winston-Salem has 30 years of experience working in the Medicaid system and has taught family policy at the UNC School of Social Work.