An open letter to North Carolina Senate leader Phil Berger
To: The Honorable Phil Berger
President Pro Tem of the North Carolina Senate
State Legislative Building
Raleigh, NC 27601
Dear Senator Berger:
My purpose in writing to you today is not political. It is not about blame. It is not about playing a game of “gotcha,” dispensing recriminations or scoring points. Frankly, that would be futile. No matter what happens in 2015, you, like your predecessor, former Senate leader Marc Basnight, are all but assured of remaining North Carolina’s most powerful politician for years to come.
This letter is, instead, a heartfelt plea – the kind of plea that a parent might issue on behalf of a child to a judge with the power to grant leniency in a criminal case or perhaps to a chief executive with the power to grant clemency to someone already serving time.
A hell of a mess
The subject of the letter is one on which there has been a great deal of heat in the political arena in recent months but, sadly, not much light. Indeed, it is a subject on which public officials and advocates of all political parties and ideologies have made errors and incorrect assumptions and used inaccurate language.
And, sadly, it is also a matter of life and death. Please, just take a few minutes to hear me out.
The issue, of course, is access to decent and affordable health care and whether or not North Carolina will act to help a half-million of its citizens to obtain it.
And as long as this is a plea, let’s also start out with an important admission on the subject – namely that the Affordable Care Act (aka the “ACA” and “Obamacare”) is a flawed and overly complex law. Anyone who is honest must admit this fact.
Like the proverbial horse designed by a committee , the ACA is a weirdly shaped and homely creature. At just about any minute, one can easily envision its missing a step and doing a pratfall on the sidewalk.
Sadly, however, this is how we often do things in this complex and closely divided democracy. For many years now, American elected leaders have been cranking out 1975 Gremlins  when what was needed was a fleet of 2015 Teslas . That said, the ACA is what we have and no other rides will be coming along in the foreseeable future to get us where we must go.
Closing the insurance gap
With all this as predicate, let’s really consider what’s genuinely at issue today in North Carolina in the debate about the ACA.
Right now, the Obamacare mandate is the law. It already applies to the entire country and everyone is affected. That decision has already been made and cemented by the U.S. Supreme Court. The question now is how, as a practical matter, we will make it possible for a large swath of lower-income working Americans to comply with the mandate and participate?
Sadly, many observers of varying political persuasions labor under the inaccurate impression that the debate is whether to expand Medicaid — the public health insurance system for the poor – in order to cover a giant group of people who are already participating in the private market (and even receiving public subsidies).
Recently, in fact, one of your fellow conservative skeptics of the law, veteran State Representative Paul Stam explained his opposition to “expanding Medicaid” to a TV interviewer  by claiming that the ACA already provides subsidies to the hundreds of thousands of uninsured North Carolinians (with money “borrowed from the Chinese”) and that it would therefore be an enormous and costly error for North Carolina to bring these people into the public insurance program (i.e. Medicaid).
While this is perhaps an understandable error – Rep. Stam is usually no dummy – it is plainly and simply not true.
The fact of the matter  is that the half-million or so North Carolinians in question do not have health insurance or realistic access to it because they simply do not make enough money and are not eligible for an Obamacare subsidy.
That’s the “coverage gap.” Do you see now?
The authors of the ACA thought it more cost effective and logical to cover such lower income working Americans with Medicaid rather than provide them with subsidies to buy insurance in the private market. They assumed all states would readily go along with the idea since the feds would be paying almost all the cost. And while we can debate whether this was a wise policy decision, there’s simply no denying that it is the policy and that, as a practical matter, Medicaid coverage is therefore the only possible way to bring these people within the law.
If you doubt this Senator, please click here  to read the story and watch the accompanying video that describes the situation confronting a young woman from Charlotte named Dana Wilson who was diagnosed with Multiple Sclerosis at age 22. This is from that story:
“Because Dana had a pre-existing condition, most health insurance companies refused to even consider her for coverage. On the rare occasion that an insurer would provide coverage, the plan came with a monthly premium of over $1,000 per month. But that all changed when Congress passed the Affordable Care Act, which prevented health insurance providers from refusing coverage to people with pre-existing conditions. The law also provides subsidies to help people afford coverage, and raises the Medicaid eligibility for people near or below the poverty line.
Unfortunately, Dana’s income status disqualifies her from receiving subsidies to purchase health insurance on the health insurance marketplace. While she is eligible for expanded Medicaid coverage under the Affordable Care Act, Gov. Pat McCrory and the General Assembly’s refusal to accept the expansion means she cannot receive Medicaid either. Dana is one of the thousands of North Carolinians that Medicaid expansion was designed to help. But because of our state’s refusal to expand the program, they have fallen into this coverage gap.”
Do you see now? She has no other option. She wants to work and does. Indeed, she makes too much money to qualify for Medicaid under our current standards. But her disease prevents her from working enough to make enough money to qualify for an Obamacare subsidy.
This simply makes no sense. Even if you hate the President and the ACA as a matter of principle and want to rail against them both, how can one support a policy that punishes such a person (and hundreds of thousands more like her) so directly and denies her the affordable insurance that would dramatically enhance her life?
The only person who can solve this problem
This brings us back to the purpose of this letter, Senator.
Here’s the hard truth about where things stand in North Carolina right now: Dana Wilson’s life and the lives of hundreds of thousands of North Carolinians like hers are in your hands. You are without question the most powerful law and policy maker in North Carolina in 2015. As anyone paying any attention to the power dynamics in Raleigh can plainly see, Gov. McCrory and House Speaker Tim Moore will clearly follow your lead on this matter.
You possess the power to directly and almost immediately improve the lives of hundreds of thousands of human beings like Dana Wilson. Several thousand will actually live longer if you act. All that is required is for you to give the word.
Heck, you can curse the ACA and blame President Obama that such an absurd conundrum exists as you do it. Do it with a scowl on your face. Give it another name. You have all the money and power you need to spin the politics any way you please. We’ll promise not to praise you if that would help.
Please though, just this one time, put the politics aside and save some lives.
With utmost sincerity,