North Carolina is among the 14 states in the nation that have still yet to adopt any sort of Medicaid expansion plan, leaving over one million people—or one-tenth of the entire state’s population—to rely on emergency rooms and urgent care facilities for all their medical needs. As Republicans revealed today, there is literally no good reason for this.
Medicaid expansion has easily been the top talking point in the Tar Heel State over the past month, as the GOP leaders in the General Assembly have traded barbs with Democratic Gov. Roy Cooper over the 2019-2020 state budget. The House, still controlled by Republicans, drew its line in the sand and set up the present battle in May, when they proposed a budget that did not include any plans for expansion.
Some important context: For the past eight years, the GOP legislature in North Carolina, along with much of the rest of the South, has passed on the (literally free!) federal funding available for Medicaid expansion. Because of their longstanding inability to combat blatant racism and class warfare in an efficient manner at the polls, the Democrats in the General Assembly were effectively voiceless that entire time period. Unfortunately for the GOP and fortunately for everyone else, their supermajority died last November, meaning that while they still control both chambers of the legislature (they own the Senate 29-21), they can no longer simply override the governor’s veto to pass whatever hellish budget they want.
So on Tuesday, GOP leaders in the state Senate sent a letter to Gov. Roy Cooper (but mainly to the press) outlining their issues with Medicaid expansion and why they will not seek to expand the program in this year’s biennial budget. Brace yourself, because things are about to get incredibly stupid:
We have communicated for months our opposition to Medicaid expansion because, among other reasons: 1) there is no guarantee of continued federal funding, which could put North Carolina taxpayers on the hook for billions of dollars (e.g., N.C. Health Choice); 2) Medicaid expansion puts able-bodied, working-age adults ahead of those with intellectual and developmental disabilities; 3) expansion will force the traditional Medicaid population (children, expecting mothers, the elderly) to compete with able-bodied, working-age adults for access to limited doctors; and 4) Medicaid expansion will not solve the rural health access crisis because there are already too few doctors to care for people in those communities.
No. 1 is the most oft-used line in combatting Medicaid expansion—the underlying idea being that one day conservatives will storm the federal government and choke off the billions in funding that fuels the entire government-run healthcare operation, thus leaving states “on the hook” to keep their citizens alive. A stiff bill, to be sure, but a reality that, at least for the present moment, is eons away from becoming reality lest Republicans want a literal revolt on their hands.
As it stands, expansion would result in the federal government paying 90 percent of the cost, with the state covering the remaining 10 percent. Right now, North Carolinians are paying roughly $1 billion in federal taxes for people in 36 other states to go to the doctor; it’s probably time they send some of that money their own way.
No. 2 and No. 3 are clearly the same reason, just repackaged with the supposed victims swapped out. But in order to sustain either argument, the GOP—leaving the silent part to us to spell out—is making the case that “working-age adults” are somehow less worthy of healthcare than the young and the old, and thus believe that one must choose between providing service to some versus all. It is, as I said earlier, very stupid, seeing as the state would have to pay pennies on the dollar for expansion.
No. 4, though, is the one that really grinds my gears. The “rural health access crisis” is real. Privately operated hospitals are shutting their doors at alarming rates, and while some community-driven efforts have worked to replace them, the demand for full-coverage operations in areas that will not be cash cows for nation-wide hospital chains still far outweighs the supply.
Medicaid expansion will not solve the fact that many North Carolinians have to drive an hour or more to take their kid to a damn check-up. It would, however, help people simply be able to do that without bankrupting themselves, which is a step in the right direction while we fight for a more humane system that isn’t driven by profit, such as Medicare for All. (This GOP point also completely ignores the fact that seven CEOs of rural hospitals in North Carolina literally called for Medicare expansion two months ago!)
The minute the Republicans made their intentions—to continue fucking over one million people—clear, Democratic leaders in the General Assembly and other legislative experts were confident that Cooper would veto the budget in its present form. That moment still hasn’t come yet, because the House and the Senate are currently trying to perfect their proposals (the House rejected the Senate’s budget proposal two weeks ago) before they send a finalized plan off to Cooper.
Neither plan included Medicaid expansion, so in all likelihood, the plan will be vetoed and a game of chicken will ensue, and maybe one million people will be able to go to the damn doctor. Or maybe they won’t! Politics is a land of contrasts.