It’s a popular argument against NC taking federal money to expand Medicaid under the Affordable Care Act and it goes like this: “Well, it’s a good thing to expand Medicaid to 500,000 working, low-income NC citizens, but we just can’t be sure that the federal government will always provide most of the money for the expansion so we had better not help our fellow citizens.”
Poking holes in this argument isn’t hard. After all, many states with Republican governors and legislators realize having the federal government cover 100% of the costs of the expansion for three years and never less than 90% thereafter is a good thing. Indeed, the NC Institute of Medicine estimated that NC actually saves $65 million over the next eight years because state and local governments are already paying so much for mental health and expensive ER care for folks who would get Medicaid coverage. And, of course, there’s the fact that the federal government has never not paid its share of the Medicaid program to any state since Medicaid’s inception in 1965. Even during last year’s fiercely partisan partial federal government shutdown, Medicaid money kept flowing to the states just as it always has. Finally, of course, Medicaid expansion isn’t permanent. NC legislators can always change their mind and rescind the expansion if indeed, the “money isn’t there.” Some states did put this in as part of their expansion programs, for example requiring that the expansion automatically end if the federal government’s share ever dipped below paying for 90% of the costs.
To these good reasons for expansion let me add one more: For NC legislators to take the stance that we shouldn’t take federal money for major state-federal projects in NC because “it might run out” is highly hypocritical. Why? On the same day – in fact in the same hour – as NC House members passed the bill rejecting the Medicaid expansion in North Carolina citing as one of the major reasons that the federal money might “not always be there,” they passed another bill. This second bill – taken up immediately after the vote blocking federal Medicaid money in NC, was on a bill paving the way for NC to obtain major federal government funding for the Interstate 540 loop south of Raleigh. [See the "Block Medicaid Expansion" bill here. See the I-540 bill here. See news coverage of the federal money and the I-540 bill here. See the NC House Calendar for the day in question here.]
The I-540 bill – of course – sailed through the NC House with no one questioning that the millions of dollars of matching federal investment for Raleigh’s latest loop freeway might not come through. Indeed, some House members stood up to talk about the importance of getting matching federal money for this southern loop when, just a few minutes before, they had been questioning whether matching federal money for health care would be available. How do I know this? I was sitting in the NC House chamber and heard them speak.
A Medicaid expansion in NC would mean $15 billion in federal money coming to NC over the next eight years. States that have already expanded Medicaid this year are just starting to see the enormous economic benefits that sort of investment in a state can generate, not to mention the savings and improvements in general well-being of their citizens. I know it’s hard to argue against this sort of investment in our state’s health, but politicians certainly shouldn’t try by using arguments that are so blatantly hypocritical.