Commentary, Legislature

The continuing madness of North Carolina’s rejection of Medicaid expansion

When they write the book on Republicans’ dominance of NC politics — although, really, I don’t want to read it, living it once is enough — here’s what they’ll say:

Yes, the decade’s economic resurgence did nothing for NC’s enduring poverty problem. Yes, the legislature’s reactionary, partisan wedge politics made NC the poster child for backwards views of LGBTQ issues. Yes, the state’s reputation for moderation and education took a nose dive. And yes, despite all of those things, despite all of those glaring errors, there is not much in the last decade that will compare to the sheer inanity of Republicans’ blockade of a federally-funded Medicaid expansion.

In two years, we’ll be a decade in the hole with Medicaid expansion, forgoing billions in federal dollars that could have stabilized hospitals, injected cash into the economy, aided the poor and made NC a healthier state if not for the fact that Barack Obama’s name was stamped on the money and represented some part of a social safety net that the GOP despises with reckless abandon. Indeed, the GOP would defy a majority of North Carolinians and health care experts, many of their own party’s most prominent leaders and logic itself to flout expansion.

Whether they pay a political price is up for debate; but the price for the poor and anyone with limited access to health care is not, as last week’s report from the nonprofit Kaiser Family Foundation found in examining NC health care. The McClatchy editorial board offered up this editorial Sunday that sums up the madness of the GOP blockade.

Read on for the money quotes:

North Carolina’s uninsured numbers would be worse had it not been for the Affordable Care Act, a law that the state’s legislative leaders resisted at every turn. Nonetheless, 447,680 North Carolinians were enrolled in ACA plans in 2019, with 94 percent of them receiving a tax credit to help them pay their premiums. If North Carolina had expanded Medicaid in 2018, the report estimates that 357,000 uninsured adults would have been eligible for the state and federal health insurance program.

To create a healthier North Carolina, expanding Medicaid is the biggest and perhaps the simplest step. But the state must also do more to reduce the causes of poverty and close the racial gaps in health conditions. That means increasing the minimum wage and the number of small businesses that offer health insurance benefits. Among North Carolina private businesses with fewer than 50 employees, only 19 percent offer health insurance, compared to 29 percent nationally, the KFF report said.

The state should also require employers to offer paid leave to workers when new children are born or adopted, or when serious personal or family health issues arise. Currently, only 12 percent of North Carolina’s workers have that benefit. Creating more parks for exercise and better access to healthy foods would also help.

Every 10 years, the state announces its health goals for the decade ahead. This year the state’s “Healthy North Carolina 2030” report called for action beyond wider access to health care. The report says, “Long-term sustainable improvements in the health and well-being of North Carolinians will only occur by addressing the social, economic, and place-based challenges that keep people from achieving optimal health.”

Tax cuts and holding out on Medicaid expansion won’t do that.

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