Call it an exercise in futility? Well, no.
There may not be a chance in the world that the General Assembly’s Republican chiefs will let the latest proposal to expand Medicaid come to a vote this year, or even receive a fair hearing in the committees they control.
But by pressing the case, advocates continue to hammer home the benefits of expansion – and perhaps nudge Gov. Pat McCrory to find a way to untangle an impasse that has left many thousands of low-income North Carolinians struggling to get by without health insurance.
Already, McCrory has taken a more moderate position than his ostensible Republican allies in the legislature, whose guiding principle when it comes to a broader Medicaid program seems to have been, “No way, no how!”
The governor has suggested he might be open to changes that would bring more people under the Medicaid umbrella, although using some yet-to-be-devised approach that would stop short of embracing the kind of expansion envisioned under President Obama’s Affordable Care Act.
Any reboot, McCrory says, will have to await the US Supreme Court’s ruling in a case brought by conservatives that could wreck the system of insurance premium subsidies on which the ACA depends.
Still, he leaves open the possibility that he might join some other Republican governors who seem ready to work with the Obama administration in their states’ interests, rather than hold to their party’s hostility to the law that critics sneeringly call Obamacare – as if making health insurance more accessible to millions of Americans were a hideous mistake rather than a milestone of social progress.
Signers say, bring it on
McCrory now is being asked to contemplate the fact that for many folks in North Carolina, expanding Medicaid would be a popular move.
Expansion supporters on March 24 brought petitions with what they said were about 25,000 signatures to the Legislative Building as they unveiled bills seeking to overturn a Republican-backed law meant to take expansion off the table. The petitions were headed for the governor’s office.
House Bill 330 has four primary sponsors: Democratic Reps. Verla Insko of Chapel Hill, Beverly Earle of Charlotte, Gale Adcock of Cary and Joe Sam Queen of Waynesville. The bill has been referred to the House’s Committee on Health.
Senate Bill 365, identical to the House measure, has as primary sponsors Sens. Terry Van Duyn of Buncombe County, Valerie Foushee of Chapel Hill and Gladys Robinson of Greensboro. It was referred to the Rules Committee – not a good sign, since that committee often serves as a graveyard for bills opposed by Senate leaders.
The legislation would broaden Medicaid in North Carolina along the lines first mandated by the Affordable Care Act – before the US Supreme Court told states they could choose not to participate. Medicaid is funded largely by the federal government, but states must put up a matching share.
Tar Heel Republicans aiming to keep taxes down, especially for high-end earners, and meanwhile to gum up Obamacare just for the partisan fun of it cite Medicaid’s high costs as reasons not to expand the program.
Yet they’ve downplayed the fact that under the ACA, states opting for expansion have had the additional costs picked up by federal taxpayers for the first three years. Top Republicans in the legislature also have glossed over North Carolina’s admirable cost-control record, with per-capita Medicaid outlays at the low end of the range.
Sponsors of the new bills say that far from costing the state money, Medicaid expansion would mean an influx of federal funds – an estimated $2.5 billion over the next two-year budget cycle. The opponents’ response seems to be that, well, maybe at some future point, federal spending will dry up and the state will have to make up the difference. Sure, and a wayward asteroid might make the whole subject moot.
In from the cold
Here’s why it’s so important to expand Medicaid, which now covers very-low-income families with children, as well as disabled adults and the low-income elderly.
Childless adults, no matter their income, and even some parents who earn less than the federal poverty level — $11,770 for a single person this year; $20,090 for a family of three — aren’t eligible for Medicaid and have to fend for themselves if they want to buy health insurance. Good luck with that, since health insurance tends to be expensive. And the ACA’s premium subsidies, intended to make insurance more affordable for low-income folks, don’t apply to these poorest of the poor. That’s because under the ACA, Medicaid was supposed to be broadened to cover them.
Under the pending bills, people earning up to 133 percent of the poverty level could sign up for Medicaid. The numbers may be rather dry, but consider the impact on real folks trying to deal with the real hazards of sickness and disease.
With Medicaid coverage, a person who needs medical care – perhaps from a bout of flu, perhaps from a chronic condition such as high blood pressure or diabetes – can afford to see a doctor. What are the alternatives? Go to the hospital emergency room, where costs are defrayed by passing them on to other patients who have insurance (meaning insurance rates are driven up) or where costs are simply swallowed (not happily) by the hospital itself. Or, tough it out without treatment – a formula for short-term suffering or possibly a shortened life.
The bottom line: Even in a country that prides itself on the quality of its health care, a failure to expand Medicaid will continue to leave millions of Americans – and upwards of 300,000 North Carolinians – unable to afford basic health treatment and dependent on the charity of others.
At the same time, failing to expand will deprive this state of a small fortune in funds partially provided by its own federal taxpayers – funds that could bankroll a host of health-care jobs and help sustain hospitals now swamped with the expense of caring for folks who can’t pay.
It’s plain to see, then, that Medicaid expansion makes sense both from the perspective of compassion and economics.
Gov. McCrory will have a tough row to hoe in terms of convincing the legislative powers to accept a broader Medicaid program, even one tailored to North Carolina specs. Still, as he prepares for a re-election campaign, he surely understands that to bow to his party’s hard-liners is to risk alienating those centrist voters on whom the contest may well turn.
Even if the legislature’s anti-Obama zealots are determined to frustrate any vestige of Obamacare, McCrory can help himself by working to resolve this critical issue. Any approach that enables thousands of North Carolina’s poorest residents to see a doctor when they’re sick, just as the more fortunate among us can do, stands to boost him not only politically, but also in the eyes of history.