Back when the legislature first went into session, Governor Cooper’s legislative director Lee Lilley declared, “Session ends when we get Medicaid expansion.” It was a bold statement then. It’s set the tone for the end of the session now. 

The House and Senate have both passed versions of a budget that doesn’t include Medicaid expansion. Last night, Senate President Pro Tem Phil Berger shut down Senator Terry Van Duyn (D-Buncombe) as she made a passionate defense of expanding Medicaid. The House and Senate leadership appear determined not to offer coverage for up to 500,000 North Carolinians who lack insurance now. 

Expect Cooper to veto any budget that lacks Medicaid expansion. If Democrats can sustain it, we may not get a budget this year. Republicans controlling the legislature could adjourn and force the state to operate under the same budget constraints passed in 2017 and 2018. That means no raises for teachers or state employees. The fight over Medicaid expansion could set the stage for the legislative elections in 2020.

Republicans claim that Medicaid expansion is too costly. So, far they’ve been wrong about most of their health care predictions. Obamacare didn’t collapse the economy or the insurance market. Instead, despite GOP attempts to sabotage the Affordable Care Act, premium increases slowed, out-of-pocket spending decreased and we have more people insured than at any time in history. As a result, the program has become increasingly popular.

Opposition to Medicaid expansion is more ideological than practical. Contrary to GOP claims, studies have shown that expanding Medicaid doesn’t break the bank. States that expand Medicaid have seen savings directly through reduced costs of uncompensated care and increased economic activity because of a healthier populace. In addition, Medicaid expansion saves rural hospitals. That’s why the hospital CEOs across the state support Medicaid expansion.

Medicaid expansion is probably a good issue for Democrats heading into 2020. They can argue that it saves hospitals, lowers costs and covers more people. Republicans can argue that it will cost the state too much money but that’s a bit rich when they continue to cut taxes for businesses and have shifted the tax burden from the wealthiest North Carolinians to the middle class.  Their priorities are pretty clear and they don’t include the health care of middle and lower-middle class families.


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