“Two Americas” in health care: Implementing Obamacare in a Red State

In the latest edition of the New England Journal of Medicine, two UNC researchers, Jonathan Oberlander and Krista Perreira, give an overview of Obamacare implementation in NC and the emerging great divide in health care. In this coming year, where you live, rather than just the fact you are an American citizen, is going to have a huge impact on your ability to get health care:

The ACA is a national law, but its implementation varies substantially across the country. Two Americas have emerged in health care reform: states like California, which have embraced Obamacare, have enthusiastically implemented key provisions, and are intent on boosting enrollment and ensuring its success; and states like North Carolina, whose political leaders oppose Obamacare, resist its implementation, reject Medicaid expansion, and hope that the program collapses.

I think it’s worth reading this piece with Ezra Klein’s latest musing today on the same issue in today’s Washington Post. Klein points out the Republican hypocrisy on health care: after years of pushing insurance exchanges, availability of high deductible health plans, and competition – all features of Obamacare – they are suddenly loudly protesting those very features.  Why?  Apparently just because Obama incorporated them into health care reform.  As Klein writes:

We’ll see whether Obamacare withstands the onslaught. But either way, once the assault is over, what kind of health policy will Republicans be left with? How can they propose anything that will cancel plans or raise deductibles or tighten networks? How can they propose anything at all?

Reading these together I think you can see the dilemma for Republicans in North Carolina. As states that are moving forward with Obamacare experience the enormous economic and social benefits that come with finally making sure almost everyone is insured it will become harder and harder to block Medicaid expansion and continue to resist implementation.  After all, our relatives who live in states like  Kentucky now have easy access to a wide variety of health plans and a guarantee if they lose a job they may have plenty of worries but going bankrupt from a serious accident or disease isn’t one of them.

In the end, it’s hard for Governor McCrory and state legislators to explain why people in a majority of states have those benefits but not in North Carolina, especially if they have no credible alternatives to offer as to how they would solve our health care problems here.


  1. dw

    December 13, 2013 at 9:29 am

    This is no longer about politics but about intelligence. The average household income in NC is $45,000. ACA tax credits and subsidies have a huge impact on those in this income range to save thousands of dollars a year. If the citizens in this state want to be lemmings they will be the losers not the politicians. The politicians already turned around and are signing up for the ACA. Politicians have led the public down a dead end street and now they will abandon them there.
    Unfortunately, for all who have paid federal taxes, NC residents are being screwed by not accepting Medicaid funds that other states are gladly taking. Again, this is about intelligence (or lack of)!!

  2. GOP Rules

    December 13, 2013 at 1:08 pm

    dw/ML/Policy Watch intern,
    There is great intelligence involved in rejecting the train wreck of Obamacare, and specifically Medicaid expansion. The federal government is “promising” to pay 100% for a limited time…and even that is iffy….do you think when the feds cut off funding when the next rainy day comes it would be wise to have thousands of more people on a program that has been proven to be badly broken and unaffordable already? This is the best choice the NCGA has made in several decades, and if someone wants to go take full advantage of Obamacare, there are ways to take advantage. Just move to another state where the socialist utopia is being embraced.


  3. Alan

    December 13, 2013 at 6:13 pm

    I wonder if the ACA were still a Heritage policy plan, would GOP Rules & the rest of the Civitas interns be posting about it’s merits, or would it still be a “train wreck”?

    The New York Post, a highly respected media outlet, normally placed alongside the toilet tissue in your grocery store….

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