The latest lame excuse for holding up Medicaid expansion

For nearly a decade, North Carolina has forgone billions of federal dollars, prevented the creation of thousands of good jobs, caused multiple rural hospitals to close, and most disturbingly, condemned thousands of uninsured people to an early death by refusing to follow the lead of 38 other states in expanding Medicaid.

As scores of experts, advocates, public officials and average North Carolinians have repeatedly attested and evidenced in literally hundreds of reports, studies, essays, speeches, testimonies, commentaries, press conferences, polls, and heartfelt pleas, Medicaid expansion is a thoroughly obvious and urgently needed step for our state.

The NC Department of Health and Human Services spelled out this undeniable fact in a succinct and compelling summary a few months back. It noted that expanding Medicaid under the terms of the Affordable Care Act would, among other things:

• save the lives of as many as 1,200 North Carolinians per year,
• dramatically increase access to mental health and substance abuse treatment,
• bring affordable health coverage to more than 100,000 low-income parents with children,
• build a healthier workforce — especially in the service industry — while helping large numbers of people with disabilities enter the workforce,
• protect more than 14,000 uninsured military veterans and their families, and
• provide a big boost to rural health care, hospitals, and families.

Of course, these facts (and the arguments and pleas to which they gave rise) have been quite visible for years, but they have still fallen on deaf ears in the state’s Republican legislative leadership. Egged on by right-wing think tanks for which ideological opposition to virtually all public structures and systems is something akin to a faith, these lawmakers repeatedly concocted excuses.

Expansion would be too costly. The federal government would soon stop underwriting 90% of the cost. The state Medicaid program had to be overhauled and reformed before it would be ready to expand. The uninsured who would gain coverage were lazy and undeserving.

At one point, in a show of rather remarkable brass, opponents even tried to argue that people enjoy better health outcomes without any health insurance at all than they do when enrolled in Medicaid.

Eventually, however, the weight of the facts was so overwhelming that GOP resistance began to crumble. The idea of expanding a public healthcare program clearly still rankles many Republican lawmakers, but the numbers are so compelling, the benefits to the state so obvious, and public support for the idea so strong, that the politicians who blocked expansion have, effectively, acknowledged the error of their ways and become supporters. State Senate leader Phil Berger is perhaps the highest profile convert.

Unfortunately, as one might have feared in these maddeningly fractious times, this long overdue conversion hasn’t yet led to action. Instead of simply allowing a clean and simple expansion vote, Berger and some other Republican legislative opted to inject another even longer-in-the-tooth healthcare debate long championed by those same conservative think tanks into the discussion– the battle between hospitals and other medical providers over so-called “Certificate of Need” laws.

As Raleigh’s News & Observer recently reminded, Certificate of Need (CON) laws, are a long-established tactic used in a sizable majority of states and encouraged by the federal government to assure that high-priced healthcare equipment and services are distributed equitably.

The basic idea is that the state assures that when healthcare providers expand they don’t do so in a way that causes services to be harmed elsewhere. The classic example that CON laws might prevent: a medical practice installing a new and highly profitable piece of equipment that would harm a nearby rural hospital that relies upon revenue from such equipment to underwrite its other unprofitable primary care services.

Now admittedly, the CON debate is a complex one.

While CON defenders advance strong arguments for preserving the protections, their reasoning is not always bulletproof. There are clearly circumstances in which CON laws have stood in the way of healthy competition that would benefit consumers and promote efficiency. And the process of sorting out CON disputes can take a great deal of time.

But here’s another undeniable truth about this new CON law debate: Medicaid expansion is on hold yet again because parties can’t settle this very separate disagreement and, as a result, hundreds of thousands of  people — most of them in households that include workers struggling to make ends meet at low-paying jobs — continue to suffer.

And this makes no sense.

While the Certificate of Need issue is important, it’s ultimately about a battle that will always be there – namely powerful interests fighting over profits. We’re not, after all, holding up Medicaid expansion because insurance and pharmaceutical companies are making exorbitant profits that impact healthcare costs. Even House Speaker Tim Moore told the N&O “we can take care of expansion, and deal with all that other stuff at a later date.”

Now it’s important to point out here that Berger and Moore have been trading hats and playing the good cop/bad cop shtick in the Medicaid debate for so long now, that it’s hard to know who to really believe.

But one thing is for certain: the fact that lawmakers are using more than half a million uninsured North Carolinians as political pawns in a cynical political game ought to be unacceptable.