The people of North Carolina pay federal taxes. Our tax dollars help fund the 90 percent federal match on Medicaid expansion enrollees for states that have expanded Medicaid under the Affordable Care Act. The North Carolina General Assembly has not expanded Medicaid for North Carolinians. Not only does this leave half a million of our neighbors without health care coverage, it also leaves billions of federal dollars on the table. Dollars that North Carolina tax payers sent to Washington. Dollars that Washington is trying to send back to North Carolinians who qualify for healthcare coverage under the law of the land.
Many of us are so desperate to break through this illogical dystopia, we’ve come to see ill gain as good gain. The current proposal to “close the gap”—we dare not call it Medicaid expansion—by charging people a premium and imposing a work reporting requirement is hailed as progress.
Sometimes wrong is just wrong, not a little bit wrong or almost right. Just wrong. Denying health care coverage to nearly half a million people is wrong. When we consider the positive ripple effect that coverage would have for their communities—dollars into N.C. means dollars out to the clinics, hospitals, pharmacies, providers—it just gets more wrong. We have strayed so far from acceptable measures of justice in N.C. that any move in that direction is hailed as a victory, even while it’s still wrong.
We are “straining gnats” (Matthew 23:23-24). Work reporting requirements and premium payments are like the “mint, dill, and cummin” measured out by legalists who neglect the “weightier matters of the law: justice, mercy, and faith.”
The data is there to show that requiring premiums creates affordability challenges for people with low incomes in need of health coverage. In the end, they must choose between premiums and groceries. The groceries rightfully win and health coverage is lost, putting us right back where we were. Likewise, a work reporting requirement has been shown to create administrative challenges, to say nothing of being ruled illegal in states that have tried it (Arkansas and Kentucky). Truth is, according to a Kaiser Foundation report, nearly 8 in 10 Medicaid adults are in working families, and most (59%) are working themselves without being required to do so as a condition of coverage. Many others are family care-givers or people who have barriers to work as a result of chronic pain, dental needs, or other untreated medical conditions.
Besides, Medicaid is a healthcare program, not a jobs program.
It’s Holy Week in the Christian faith. For practitioners of this tradition, the call to do justice and love mercy ranks supreme. There is no need to compromise. We can have Medicaid expansion and all the good it brings without the encumbrance of regulations and stipulations. And that would not be wrong.