NC's failure to expand Medicaid takes its toll

Published October 15, 2013

Editorial by News and Observer, October 14, 2013.

How easy it was for Gov. McCrory and Republican leaders of the General Assembly to ignore the consequences of their decision to reject the federal government’s offer to expand Medicaid. Washington would have paid the entire cost, for three years, of adding 500,000 people to the federal/state health insurance program for the poor.

And, the federal government would have covered 90 percent of the cost thereafter. The expansion was part of the good program Republicans love to hate, the Affordable Care Act. Under it more people would be on Medicaid, most of the other uninsured would be able to buy insurance though health care exchanges, and with more individuals covered, insurance premiums for all likely would go down.

But while they were on a roll in the last session, bashing public school teachers, cutting unemployment for jobless North Carolinians and cutting education in general along with other worthwhile programs, GOP lawmakers and McCrory said no to more Medicaid participants. The problem, they said, was that the federal government would probably go back on its promise to pick up the cost.

There was no basis for that suspicion. The federal government has paid its share of Medicaid for decades.

Others followed the absolutely nonsensical argument offered by some of their fellow lawmakers, such as Rep. Nelson Dollar of Cary. He claims that most of the people who would have been covered by Medicaid expansion are “relatively healthy” and could always get care in emergency rooms. Wow. Really? Dollar does not have a medical degree but appears to have a crystal ball that permits him to diagnose half a million people. His argument is ridiculous and disputed by health care professionals.

People don’t get comprehensive care in emergency rooms, because emergency rooms aren’t set up to engage in preventative care and management of chronic diseases.

Among those who favored Medicaid expansion were hospitals. They would have gotten more money to enable them to provide the care. The failure to expand is expected to cost state hospitals over $600 million. How in the world is that good for the medical care system, and for individuals?

The failure to expand also means that those 500,000 people won’t have access to regular doctor or clinic visits. That means some of them will wind up in emergency rooms with spiking blood pressure or diabetes symptoms. Access to a doctor’s office and preventative care would save the currently uninsured money, save hospitals money and save insured patients money, because their premiums wouldn’t increase to cover the cost of emergency room care for the indigent.

But, no, said Republicans, with a “let them eat cake” attitude. They put the boot on the necks of lower-income people just because they don’t like the signature achievement of a Democratic president who has been twice elected. Make no mistake. There would have been no cost to the state, so this is not about money. It is about a governor and a General Assembly that worried more about cutting taxes for the wealthy and business than serving the people of this state.

So here’s what’s happening, as demonstrated in a Sunday story in The News & Observer and the Charlotte Observer: Poor people who are sick are not able to get the care or buy medicine they need. Without insurance, they are more dependent on charity for their very survival and at risk of getting sicker, losing their homes and moving to shelters. They are hurting, and they are desperate.

Some relief could have been granted them with the simple act of doing what half of all states did, expand Medicaid. All the states, except Arkansas, in the Deep South, where the anti-Obama sentiments are strongest, rejected expansion. Republican lawmakers have no reason for their actions except that they don’t trust the president of the United States. That’s not very comforting to good citizens in need.