On an important anniversary, sound advice for North Carolina from a conservative Republican
Published March 24, 2022
Sometimes, when discussing important topics of public policy, it’s useful to dispense with all the talk of data and budgets and legal fine print and get down to what really matters: the impact on human beings.
The subject of Kasich’s presentation was Medicaid, the American health insurance program for people of low income. This week marks the 12th anniversary of the enactment of the Affordable Care Act – a federal law that gave states the ability to expand eligibility for Medicaid to cover a broad swath of people with incomes too high to qualify under previous income thresholds and too low to afford insurance on the open market.
At the time the law was enacted, it seemed to most observers a foregone conclusion that the benefits would be sufficient and obvious enough to convince all states – even deeply red ones – to opt for expansion. The financial incentives were enormous; the law provided that the federal government pays the vast majority of the cost. The economic benefits to a state that would result from an annual influx of billions of federal dollars – in the creation of jobs and added stability for rural healthcare systems, among other things – were undeniable.
Now add to this the fact that most uninsured households stuck in what’s come to be called the “coverage gap,” had (and have) no realistic option for finding affordable private health insurance and must invariably rely on charity care, and the case for expansion was boosted still further.
Today in the non-expansion state of North Carolina, for example, the adults in a family of three with an annual income of between $9,122 and $21,720 are out of luck when it comes to Medicaid eligibility. Amazingly, at even $200 per week, they make too much to qualify and too little to receive a marketplace subsidy – even though it’s absurd to think that such a household could afford hundreds of dollars per month for private coverage.
Tragically and amazingly, however, several states – all led in whole or in an essential part by Republican politicians – resisted expansion. And though the number of holdouts has slowly dwindled over the years down to a stubborn collection of 12 – a majority of the old Confederacy (including North Carolina) plus Wyoming, South Dakota and Wisconsin – the resistance remains deeply and almost weirdly passionate.
Especially among Trump loyalists – a huge percentage of whom hail from struggling, job and hospital-shedding rural regions with huge numbers of uninsured residents – a statement of support for expansion can quickly transform a GOP lawmaker into a magnet for a primary challenge.
All of which brings us back to John Kasich – a dyed-in-the-wool conservative Republican who embraced Medicaid expansion for his Trump-leaning home state of Ohio when he served as its governor.
Kasich clearly understood and understands the numbers. As the Washington Post reported during his 2016 presidential run, “He is a man obsessed with budgets” who “wasn’t about to turn down an expected infusion of $13 billion” for his state when Medicaid expansion became an option.
But there was another aspect to Kasich’s actions too: his personal religious faith and concern for the less fortunate. As he told a resistant Ohio lawmaker at the time:
"Now, when you die and get to the meeting with Saint Peter, he’s probably not going to ask you much about what you did about keeping government small. But he is going to ask you what you did for the poor. You better have a good answer.”
Kasich repeated that simple and eloquent argument in his North Carolina presentation last week when he asked the members of the Joint legislative Committee on Access to Healthcare and Medicaid Expansion to imagine not having health insurance and dealing with a cancer diagnosis.
“Can you imagine that?” he asked. By expanding Medicaid, he noted, we have, quote “the chance to reach out and literally hand people a lifeline.”
"What I would say to the fine members of the legislature in North Carolina, to the people in North Carolina, there’s a lot of people that need a lot of help. We have to open our hearts to those people.”
Kasich is right, of course. Studies indicate that the simple human decency he and other Ohio leaders embraced and extended to their struggling fellow citizens several years ago has prevented thousands of premature deaths in the Buckeye State. There is little doubt that a similar life-saving outcome will ensue here if and when opponents to expansion finally relent from their stubborn and purposeless resistance.
Let’s hope North Carolina lawmakers were paying close attention to Kasich’s powerful and commonsense presentation and are, as he put it, ready, at long last, to “open their hearts.”