Today, the legislature is scheduled to vote to override Governor Roy Cooper’s veto of the budget. However, the vote is inextricably tied to Medicaid expansion. Before session began, Cooper said that expanding Medicaid is his top legislative priority and an aide told reporters session would end when Medicaid was expanded. 

Republicans and their allies in conservative think tanks have been arguing against Medicaid expansion all session. Senate President Pro-tem Phil Berger wrote an op-ed laying out his opposition. It rests on three ideas. 

First, Berger says that most the people who would be eligible for the expansion are “able-bodied adults between the ages of 18-50.” Berger implies they’re deadbeats. They’re not. They’re the working poor. A lot of these people work full-time but still can’t afford insurance and don’t qualify for Medicaid. Being able-bodied and poor shouldn’t disqualify you from getting health care. 

The second argument is that the federal government, which covers most of the cost of Medicaid, could reconfigure the equation and require states to pay more of the share of coverage. Berger doesn’t want the state to get stuck with higher costs. That’s a question of values. Democrats believe that the richest country on earth should join the rest of the developed world in providing health care for its citizens. Republicans are concerned the people who have benefited the most from our current recovery might have to pay more to help out their fellow citizens who are still struggling. 

Berger’s final argument is that states that expanded Medicaid saw enrollment go up more than expected, putting financial pressure on the program. The other states that have expanded Medicaid have not seen dramatic problems even with the increases. In fact, some, like Montana, have even seen reduced state spending.

Despite GOP claims, states that expanded Medicaid have not seen budgets explode or health care costs increase dramatically. Instead, they’ve seen the number of uninsured people drop substantially and healthier populations. Hospitals have seen their revenues increase because they aren’t eating the cost of uninsured patients. In North Carolina, Medicaid expansion would probably save some of the smaller hospitals that will likely close without it. 

Despite Republican attempts to sabotage the Affordable Care Act, it’s working. In states that expanded Medicaid, the number of uninsured people has plummeted and hospitals have done better. While the costs of health care is still rising too fast, they’re increasing slower than before the law was passed in 2010. Republicans in North Carolina should focus on helping the working poor get health care as much as they do helping their wealthy benefactors get tax breaks. 

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