A Novel (And Surprising!) Political Development In North Carolina
Medicaid expansion is on the verge of passing and it's because Republicans -- yes, Republicans -- in the state legislature just voted for it overwhelmingly
Something pretty remarkable happened in North Carolina this week. The Republican legislature voted overwhelmingly to approve a Medicaid expansion bill, sending it the state’s Democratic governor, Roy Cooper. He has pledged to sign it.
There’s still work to be done. The whole thing is contingent on Cooper and the legislators agreeing on a state budget, which is no minor thing given their differences and history of standoffs. But insiders I’ve consulted seem optimistic the two sides will find a way — and that, with the now-public commitment of the state’s major political leaders, expansion is likely to go forward.
My latest article at HuffPost looks at how this all happened, why it’s so important and what it tells us about how politics works nowadays.
The potential human impact here is significant. Estimates suggest 600,000 low-income residents will become eligible for coverage once enrollment opens. If the research findings from other states are indicative, it's going to make a difference in these people's lives -- in all the obvious ways, like better access to medical car and fewer crushing medical bills, and in some non-obvious ways too. One study, for example, has found Medicaid coverage associated with reduced absenteeism among schoolchildren.
But this development is also important as a marker in political time. The authority and money for Medicaid expansion comes through the Affordable Care Act; expansion became optional when the Supreme Court in 2012 gave state officials more discretion to opt out. This was the surprising undercard of the 2012 NFIB v Sebelius decision, when Chief Justice John Roberts joined four liberals to uphold (most of) the ACA.
The hope back then was that most state officials would embrace expansion anyway, if only because it was such a good deal for the states, with feds picking up most of the cost. It didn't work out that way. Republican state officials said the federal government might dial back its contribution, that Medicaid was hopelessly broken. that it was expanding welfare with all of the usual connotations -- and, of course, that it was part of "Obamacare."
The opposition was softer in some places than others, with Republican governors in several states embracing expansion and pushing it through their legislatures (or, in the case of Ohio, going around it).
But lately expansion has come to red or reddish states only through ballot measures — i.e., appealing directly to the voters — and there aren’t many states left where that process is constitutionally available. The remaining holdouts (11 as of early this year) are nearly all in the South. The assumption has been GOP lawmakers in those states are a nearly lost cause.
As it turns out, they aren’t — at least in North Carolina. After years of saying no to expansion, the Republicans who control the legislature have now said yes, and done so by wide margins. The vote in the House was 87 to 24. In the Senate it was 44 to 2.
44 to 2!
So what explains this turnaround? This week, I interviewed some of the key players, including Cooper, who made expansion a top priority since he first ran for governor in 2016, and a key Republican who embraced the cause as his own. I also spoke to some of the local organizers who have hammering away at this, despite apparent futility, ever since the legislature first voted no back in 2013.
They all played a key role in the story. So did a changing political environment. Mere mention of the ACA still angers plenty of conservatives, but the animosity is fading -- enough that Republicans feel free to look at Medicaid expansion on its merits, to see what it can do for their communities (especially rural hospitals) and to make the kind of deals they would for any other major piece of legislation.
I put it all together into a story that left me feeling vaguely hopeful. It shouldn't be this hard to take a commonsense step to help people. But it's nice to see that with enough persistence -- and a little luck -- it can happen.
Here’s the URL: https://www.huffpost.com/entry/north-carolina-republicans-medicaid-health-care_n_641e0c52e4b03793a8af8d03
Thanks for reading!
A Novel (And Surprising!) Political Development In North Carolina
Definitely encouraging!