The overwhelming majority of Americans falling into the Medicaid coverage gap are in the South. Due to the obstruction of politicians like those running the show in North Carolina, millions of people who could be insured at federal government expense must instead do without. The scandalous result: thousands of preventable deaths each year.

As Alex Zielinski at Think Progress explains, however, there are some new and encouraging signs that cracks in the obstructionist wall are starting to show:

Red States Begin To See The Light On Medicaid Expansion

Conservative leaders may be warming up to Obamacare’s optional Medicaid expansion — a program that has been traditionally gridlocked in GOP-led states — in an emerging trend that could have a serious influence on the program’s adoption in fellow red states. Recent state elections unveiled a majority of these changes.

At first, many voters in favor of Medicaid expansion feared the recent elections would worsen their chances. And with a new, staunchly anti-expansion governor elected in Kentucky and a unwavering Republican majority in the Virginia Senate, it’s clear why. But these potential road blocks to further state expansions may be countered with other unexpected victories in other states.

The biggest surprise came out of the Louisiana election, where Democrat John Bel Edwards won the governor’s race by a landslide this weekend. He’ll fill the seat of current Governor Bobby Jindal, who has rejected the “subpar” Medicaid expansion program from its start. Edwards is a true Southern Democrat — he’s openly against abortion and gun control — but stands firmly behind progressive health care and labor plans. He’s already pledged to sign an executive order authorizing Medicaid expansion on his first day in office. This would provide immediate coverage to an additional 225,000 uninsured residents.

Meanwhile, in Kentucky, Governor-elect Matt Bevin may be softening his opposition to this Obamacare provision. During his campaign, Bevin spoke firmly about his opposition to Medicaid expansion — which already exists in the conservative state. But now that the election’s over, he’s mentioned a scaled-back attack on the expansion program. Instead of cutting off the 400,000 people who benefit from the state’s Medicaid expansion, he may work with the feds to just adapt it to his liking. This will likely still shed some benefits of the current state program, but won’t affect its users as harshly as predicted.

Kentucky’s expected action — or inaction — may have inspired an unprecedented move toward expansion in a fellow red state, where no Democrat holds a political office: Alabama. Read More


Action NC policy and public affairs director Kevin Rogers has an opinion piece in the News & Observer arguing that the ACA is here to stay, so we should get down to the business of improving the law and fully implementing it in North Carolina.

Open enrollment, he reminds us, starts November 1. Our state is a national leader when it comes to signing up residents for Affordable Care Act plans. The many people who have these policies need added protections, not repeal votes, to make their insurance plans work better. And the working poor need our state leaders to stop blocking Medicaid expansion. This interposition is causing great pain, and unnecessary deaths, all across North Carolina.

You can read the entire editorial here. Rogers concludes with this message to lawmakers:

As we enter the third ACA enrollment period, it is high time for Congress and the General Assembly to accept reality, abandon partisan tricks and move forward to improve the economic and human well-being of our state. Until then, thousands of lives will be lost each year, and billions of dollars wasted that health care consumers, taxpayers and our government cannot afford. The ACA is here to stay – it’s time to start acting accordingly.

If they heed his advice that would be sweet indeed.


You should read our earlier post about Rep. Nelson Dollar’s excellent objections to Medicaid reform. Dollar deserves kudos for pointing out that our system is not broken.

Despite these objections the legislature is charging ahead. If we want reform, however, the state needs to expand Medicaid at the same time. Why? Because to reform Medicaid we need permission from the federal government. According to the bill passed by the General Assembly we will officially seek this permission from the federal government by June of 2016. The Obama Administration is unlikely to make privatizing our Medicaid program a major priority in its last few months of office. That is not the sort of legacy he is interested in leaving.

If we do not get approval from the current leadership at Health & Human Services then North Carolina will need to wait until a new President takes office. Then the new President will have to nominate an HHS Secretary and we will have to wait for the Secretary to be confirmed. At some point after that HHS will begin to review our reform proposal.

Alternatively, North Carolina could include expansion in the reform plan. Then the Obama Administration would act quickly to approve our waiver. Certainly HHS is not excited about dismantling our model Medicaid system, but they could live with legislative changes if it meant covering 500,000 more people in our state.

With expansion reform will move quickly and our proposed changes will be accepted by HHS. Without expansion reform will be a long, long road to an uncertain destination.


This morning’s lead editorial in the Winston-Salem Journal calls on state legislators to slow down with the last-minute. end-of-session sausage making when it comes to selling off the state’s Medicaid program. The Journal rightfully describes the sell-off as a “huge and controversial deal” that deserves much more public input before moving ahead.

An editorial in Raleigh’s News & Observer over the weekend was even more pointed:

“GOP lawmakers want to install a managed care system in which Medicaid would be put under a new division in state government and come under the control of three contracted companies offering managed care plans. Groups of doctors and hospitals would enroll people in regional managed care networks. And Medicaid no longer would pay for each hospital visit or medical procedure for the 1.8 million enrolled in North Carolina. The companies would get a fee for each patient at the time of enrollment. If the cost of care ran over the fee, the companies would be liable.

In other words, it’s money first, people second.

This is a terrible idea. First, as has happened in other states that have tried this system, companies that find they can’t make money leave. Bob Seligson, CEO of the state Medical Society, notes that expenses also can go up. Hospitals and doctors have fought this very bad notion for years, and they’re the ones on the ground providing care….

Once again, Republican legislators move to fix something that’s not broken, even when their decisions could put the health of their constituents in peril.”

Let’s hope lawmakers make the unusual move of coming to their senses before taking this destructive step.


MedicaidThe endless 2015 legislative session appears, mercifully, to be nearing a conclusion after nine long months. With the passage of the budget early this morning, legislators are now free to wrap up final details and adjourn for the year. Unfortunately, one of those final details will be giving away the state’s award winning Medicaid program to giant, for-profit insurance companies. As Lynn Bonner reports this morning in Raleigh’s News & Observer:

“Legislators have agreed to privatize North Carolina’s $15 billion Medicaid program, a change that doctors and hospitals have been fighting for months, but which some Republican legislators have championed as a remedy for unpredictable spending.

Under House bill 372, three insurers would be given contracts to offer statewide Medicaid managed care plans. The state would have up to 10 contracts with “provider-led entities,” or groups of doctors and hospitals, that would enroll patients in regional managed care networks.

Rather than pay for each hospital visit or medical procedure as it does now, Medicaid would give the companies a fee for each patient when they enroll. The government would not be liable for cost overruns.”

In many ways. of course, this is a perfectly apt conclusion to the session. The 2015 session opened nine long months ago with one obvious and overriding imperative: North Carolina needed to follow the lead of 30 other states and expand Medicaid under the Affordable Care Act. Such an act would have saved thousands of lives per year, pumped billions of dollars into the state’s economy and strengthened an already highly effective program. The state’s feckless governor admitted these facts at times even as he manufactured excuses not to act.

Now, however, the decision has been made to, essentially, do the opposite. Rather than expanding the program to save lives, state leaders will heed the siren song of fat cat corporate lobbyists and give away this enormously valuable public asset to a handful of giant corporations that will, in turn, squeeze profits out of it by denying services to people in need.

The bottom line: More poor people will die, our economy will suffer unnecessarily and wealthy, out-of-state corporations will pad their profits. It’s hard to think of a concluding act that better symbolizes the awful 2015 session.