Then-candidate Roy Cooper made Medicaid expansion a key plank in his list of issues. Now, two years into his tenure, is the first real opportunity to do it. With Democrats clawing back a handful of seats both in the House and Senate last year, Republicans no longer enjoy unassailable supermajorities. Cooper’s veto pen has some bite to its teeth.

For anyone with a newspaper subscription or a social media account, the drumbeat of Medicaid expansion is unavoidable. Newspaper editorials, op-eds from prominent business leaders and think tank studies are constant. The chorus all sings the same note: Medicaid expansion is both the right move and the smart move for North Carolina.

The most recent study comes from the Cone Health Foundation, from the Center for Health Policy Research at The George Washington University. Verbatim, from their summary (emphasis my own):

Briefly, the analysis indicates that if Medicaid is expanded:

  • In Calendar Year 2020, about 464,000 more people will gain Medicaid coverage. This will rise to about 634,000 people in 2022, then stabilize.
  • New federal funding flowing into North Carolina will rise by $2.8 billion in 2019 and gradually climb to $4.7 billion by 2022 because the federal government would pay 90 percent of Medicaid costs for newly eligible adults. From 2020 to 2022, North Carolina will gain $11.7 billion more in federal funding.
  • The injection of billions of dollars into North Carolina’s economy will spur businessactivity, which will in turn create more jobs. We estimate that 24,400 additional jobs would be created in 2020, climbing to 37,200 more jobs in 2022, compared to levels if Medicaid is not expanded.
  • The Gross State Product (a measure of economic activity in North Carolina) would be increased by $1.9 billion in 2020 and $2.9 billion in 2022.
  • The increased economic activity and employment would trigger increases in state and county tax revenues, totaling $500 million in state revenue from 2020 to 2022 and $100 million in county revenue over the three-year period. The additional revenues can help the state and the counties address other budgetary needs.

North Carolina is one of just 14 states that have not expanded Medicaid. A graphic from the Kaiser Family Foundation shows the status of expansion as of May 2019. You will notice numerous states with divided government and Republican government that expanded Medicaid. It does not need to be a partisan issue.

Kaiser Family Foundation

While this subject deserves its own analysis, and far more emphasis, expansion would slow the collapse of rural hospitals. Verbatim from the study (emphasis mine):

  • Medicaid expansions lower hospitals’ uncompensated care burdens, improves their balance sheets and reduces the risk that rural hospital close. This may be particularly relevant to North Carolina, where six rural hospitals (Washington County Hospital, Our Community Hospital (Halifax County), Davie Medical Center-Mocksville, Yadkin Valley Community Hospital, Vidant Pungo Hospital, and Blowing Rock Hospital) closed between 2014 and May 2019 (Note: The reopening of Washington County Hospital was announced in late April.). Of the 76 rural hospitals that closed across the nation in that period, 83% were in states that did not expand Medicaid, while only 17% were in the more numerous states that expanded Medicaid, according to data from the Sheps Center at the University of North Carolina. Other North Carolina rural hospitals could be at risk if Medicaid is not expanded. Randolph Health has reported being in severe distress.

At some point, which I believe is now, there have been enough studies, enough consideration of other options and enough punting the issue. With divided government in North Carolina, the leaders of our state have an opportunity to unite and do what is best for the greatest number of people.


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