Reports today indicate Republicans have compromised in Virginia and are on track to accept federal money to cover more people under Medicaid next year starting July 1, 2014. This is six months later than the January 1, 2014 start date that federal money is available, but Virginia legislators have some reforms they want implemented in the program before they expand. Legislators have appropriated any money necessary to fund the expansion and charged a special committee to certify the reforms are in place so the expansion can proceed.
With both GOP-led Florida and now GOP-led Virginia moving toward Medicaid expansion, North Carolina GOP members of the General Assembly and Governor Pat McCrory are looking increasingly out of touch. I wrote extensively last week about the effect of the Florida decision to expand coverage on NC, arguing that the expansion decision put increasing pressure on NC politicians to get out of the corner they have painted themselves into by loudly rejecting federal money for Medicaid expansion.
The Virginia decision to expand only redoubles this pressure. Next year, over 500,000 people in North Carolina who are not able to get affordable health coverage will only have to look longingly across the border at our northern neighbor for a lesson in what GOP legislators’ and Governor McCrory’s decision means for them. There will almost certainly be extended families in border counties where some family members are able to get coverage and others are still denied care because of their address.
At this point, I’m not sure that Republicans in NC can save enough face to actually accept federal money to expand Medicaid even if every state around us expands. There has been so much lying and negative talk about what even McCrory’s own adminstration calls a national model Medicaid program in NC. One thing is certain however. With every state that extends Medicaid to the poor, especially our neighbors, the Governor and GOP in North Carolina will pay an increasingly heavy political price for their opposition. Our GOP-led neighbor states’ decision to take the federal Medicaid money makes McCrory look even more extreme and out of touch with middle-of-the-road North Carolinians. Many GOP rank and file legislators are sure to get even more of an earful from their constituents over the next year as the consequence of their votes blocking federal money becomes clear.
And just what will North Carolina’s GOP politicians say that sounds reasonable to justify their decision to not take federal money that GOP-led states like Florida, Virginia, Ohio, Arizona, and a majority of other states are eager to accept? Their worry about the federal budget? That Medicaid is “broken” even though McCrory’s own DHHS administration says any problems will be fixed in a few months and that the computer system overhaul and upgrade is on track? Maybe they’ll try and talk about “quantitative easing” like some GOP members did to justify their votes during the House floor debate. Those arguments didn’t make much sense during the debate and they’ll make even less sense when most states – including some of our conservative southern neighbors – are somehow able to figure out how to take billions in federal money to expand health coverage.
Finally, this issue will be in the news again and again. First on January 1, 2014 when most other states start Medicaid. Then a few months later as Virginia gears up its program. It will come up every time someone is turned away from getting health coverage next year. And it will be very, very clear where the blame for this tragic decision sits. NC GOP leaders may have left themselves with few options on Medicaid expansion. But every day that decision is looking like a very bad one for which they will pay an increasingly heavy political price.