Five simple truths about the Medicaid expansion debate

Five simple truths about the Medicaid expansion debate

- in Top Story, Weekly Briefing
Image: Adobe Stock

Medicaid expansion is back on the table at the North Carolina General Assembly.

Sort of.


The latest maddening and semi-hopeful development in this seemingly never ending saga arose in the aftermath of the September 11 budget veto override debacle when House Speaker Tim Moore announced that he would fulfill “a promise” to revive the GOP version of the proposal now that the House was “finished” with the budget.

Last week, the measure – House Bill 655 – was approved by the House Health Committee on a voice vote and forwarded on to the House Rules Committee. The same committee had already taken the same action on a very similar version of the proposal back in July in a 25-6 vote.

Where things go from here, however, remains very much in doubt in a body in which the leadership has a reputation for placing items on the daily calendar and then just letting them sit there, unaddressed, for weeks on end.

Will the House actually take a vote on the proposal or will the Republican leadership continue to play games? Will Democrats be allowed to offer meaningful amendments and will they receive fair and full consideration? If the measure wins House approval, will Senate President Pro Tem allow his colleagues to take it up?

These are just some of the many unanswered questions that loom over this subject – questions that, if the past is any indicator, are unlikely to be answered in a helpful way anytime soon.

Here, however, are five simple truths about Medicaid expansion that we do know for certain at this point:

#1 – It’s absurd that we’re having this discussion in late September of 2019. President Barack Obama signed the Patient Protection and Affordable Care Act into law nine and a half years ago. If North Carolina had acted as the law invited, the time for legislative action was 2013, with an expansion effective date of January 1, 2014. This means that the state has, quite literally and thoroughly, wasted more than six years.

What’s more, the 2019 session commenced in January. House Bill 655 was introduced April 9. Lawmakers have been moving at a snail’s pace throughout most of the year. If this is finally the year to move on expansion, there’s been no good reason to wait this long.

#2 – It’s absurd to argue that Medicaid must be “fixed” before it can be expanded. Medicaid, like all public and private health insurance programs, is a massive human enterprise. It will always be in a state of repair and in need of updating. To argue that it cannot be expanded until it is “reformed” – as those on the right have attempted to do – makes as much sense as claiming that we cannot enroll more students in our public schools or build new roads until our education and transportation bureaucracies are “fixed.”

#3 – It’s absurd to impose work and premium requirements on beneficiaries as a condition for Medicaid expansion. Study after study has shown such requirements to be intensely bureaucratic and inefficient (such programs often cost more to run than they bring in) and multiple courts have struck them down as illegal. Such requirements (as are included in House Bill 655) will leave tens of thousands of struggling working men and women in the coverage gap for no reason other than to provide ideological cover to conservatives.

#4 – It’s absurd that lawmakers are being denied the opportunity to cast an “up” or “down” vote on one of the most momentous policy debates to come before the state and nation in years. It’s increasingly clear that: a) North Carolinians want to enjoy the benefits of Medicaid expansion like their fellow Americans in 36 other states, plus the District of Columbia, b) the residents of those other states (none of which has repealed expansion) want to keep their expanded access to healthcare, and c) that if a vote were allowed, most lawmakers (including a large number of Republicans in both houses) would vote “aye.”

#5 – It’s absurd that, on average, about one North Carolinian dies prematurely every day because of the General Assembly’s failure to act. As the North Carolina Budget & Tax Center reported last month, a new study conducted by the National Bureau of Economic Research finds a 9.3 percent decline in annual mortality for near-elderly residents in states with Medicaid expansion. The primary reason for the improvement in life expectancy is disease management while under the care of Medicaid.

The researchers also estimate that 350 people in North Carolina die annually because of the lack of affordable health care coverage. This represents the third highest number of excessive deaths, after only Texas and Florida, among states that haven’t expanded Medicaid.

The bottom line: North Carolina could and should have expanded Medicaid years ago and saved thousands of human lives. It’s absurd that the men and women behind that failure to act can gaze in their mirrors every morning without turning to bow their heads in shame.