It’s going to happen eventually. It may not be right away and it may not look exactly like it ought to look at first, but at some point in the not-too-distant future, North Carolina is going to expand its Medicaid program.
The momentum to move forward is too strong and the arguments against doing so are just too weak. Consider the following:
- A growing and overwhelming majority of states – including many dominated by Republicans – have already taken the step and enjoyed extremely positive results.
- The healthcare community is for it and the future of many hospitals depends on it.
- A fast-growing segment of the state’s business community supports it.
- As detailed in a recent, in-depth report, the economic benefits to the state would be huge.
- Voters want it to happen.
- Most importantly, it will, quite literally, save thousands of lives.
In comparison, the arguments against expansion look downright pitiful.
The notion that the state would face fiscal jeopardy if the federal government were ever to back off of its current commitment to foot 90% of the cost is extremely farfetched. By such reasoning, the state ought never to build new highways for which the feds provide the overwhelming majority of funding. More to the point, why in the world would Congress – the overwhelming majority of which is comprised of lawmakers from the states that have already expanded – take such a politically suicidal step?
Senate leader Phil Berger’s argument that too many people may sign up under expansion and thereby somehow jeopardize coverage for severely disabled people already on the rolls is equally illogical. Why would you ever allow that to happen, Senator?
And then there’s the contention advanced in some circles that expansion would provide assistance to indolent recipients who ought to be working, As was noted in this column last month, such an argument is premised on the truly remarkable stance that it’s better that “worthy” human beings suffer and even die prematurely on a large scale than it is for disfavored, “unworthy” humans to receive basic, lifesaving assistance. Surely, this can’t be the basis for state policy in 2019.
In light of this overwhelming imbalance in the competing arguments, it comes as no surprise that there have been some new and noteworthy cracks in the conservative Medicaid blockade in recent days.
First, in a move that bore the distinct air of desperation, came the Senate proposal to aid struggling rural hospitals by simply handing them cash from the state treasury. Leave it to North Carolina conservatives to blithely violate any number of their own supposed principles in order to avoid providing direct public assistance to people in need.
Then there was the hard-to-take-serious proposal from Republicans to talk about the matter in another special legislative session if Gov. Cooper would go ahead and approve their proposed state budget.
And now, this week, after numerous past false starts, comes yet another effort in the House of Representatives to advance a kind of Medicaid expansion-lite dubbed “NC Health Care for Working Families” (previously known as “Carolina Cares”) that would allow many new people to get covered, but only if they pay costly monthly premiums and comply with bureaucratic work requirements. The bill is expected to move in the House this week.
Make no mistake: as presently constituted, the proposal is badly flawed.
Research and a growing tide of successful litigation from other states confirm that work requirements for Medicaid recipients are costly, create new and unnecessary bureaucracy and end up cutting off thousands of people who are doing their best to survive.
Similarly, a premium requirement (the new plan would charge program participants 2% of their income) will constitute a huge and often prohibitive burden. When a family breadwinner is earning, say, $18 per hour, paying an extra $63 per month can be a prohibitive expense. As with work requirements, the practical result will be to deny coverage to tens of thousands of people.
All that said, the fact that House Speaker Tim Moore is allowing the new GOP scheme to move can only be seen as a positive development. At its core, the proposal represents an acknowledgment that North Carolina’s scandalous uninsured rate and failing rural hospital infrastructure are both huge problems that must be addressed via humane state intervention.
So what happens next? Throughout the year, Gov. Cooper has stuck to the morally correct and politically astute stance – backed by Democrats at the Legislative Building – that some form of Medicaid expansion must be a part of any state budget agreement.
Now, it’s increasingly clear that Republicans are feeling the pressure to end their stubborn resistance on the issue and that the state is slowly but inevitably inching its way in the right direction. Whether this results in an agreement this summer for partial or complete Medicaid expansion or merely another election year debate with Republicans clinging to the ever more untenable “anti” position, Gov. Cooper has clearly done the right thing to move the state forward.