Column: N.C.’s Medicaid ‘compromise’ comes at a cruel cost

It's understandable that North Carolina Gov. Josh Stein decided to host a signing ceremony last week that featured a smattering of legislative Republicans when he approved new "compromise" legislation to extend funding for the state's Medicaid health insurance program. After having enjoyed precious few policy wins and endured 16 months of relentless and frequently dishonest attacks from the legislature's GOP majorities since taking office, any chance to declare a victory of sorts and conduct the kind of bipartisan event that used to be relatively normal for American governors and presidents had to be awfully appealing.

And it may well have been good politics, too. Stein has enjoyed extremely high popularity during his first year-plus in office — much higher than legislative leaders — in large part because most North Carolinians rightfully view him as a smart, sober and hard-working manager who emphasizes getting things done and eschewing the kinds of juvenile behavior that has infected public discourse in the era of Trump. Any chance to further burnish that image and seize both the high ground and center stage at a time in which his ability to influence lawmaking on Jones Street remains extremely limited is likely to boost both his and his party's long-term electoral fortunes.

As the old saying goes, "when the world hands you lemons, make lemonade."

All that said, and all the hope-inspiring imagery from the signing ceremony notwithstanding, it's important that North Carolinians understand (as Stein no doubt does) that the legislation in question — a hugely important new law that provides funding to maintain one of the state's most important public programs — is packed full of bitter pills that no amount of political imagery or good feelings can sweeten.

Simply put, as has been the case as a result of so many of the Republican-designed health policy bills enacted in recent years at the federal and state levels, a lot of North Carolinians are going to die prematurely and unnecessarily in the months ahead because of the new law's shortcomings. And that hard truth is something one wishes that Democratic legislators would have more aggressively protested, and that needs to be shared widely and continually chronicled going forward.

The reasons for this sobering fact are not at all complicated or difficult to understand. What it boils down to is that, thanks to multiple provisions in the legislation, North Carolina will now deny basic healthcare to thousands upon thousands of people in the name of "cost containment" — which is a fancy term for the state's ongoing and disastrous prioritization of regressive tax cuts for millionaires and out-of-state corporations over human need.

This, for example, is from an American Cancer Society analysis of the bill:

"This bill creates unnecessary red tape for patients seeking cancer treatment as well as anyone needing access to screenings by adding extra layers of bureaucracy and increasing patient costs."

The new law, it says, will:

● increase out-of-pocket costs significantly for Medicaid enrollees; penalize cancer patients age 19-64 by requiring the maximum allowable co-payment of $35 for each health care visit, "including those where cancer patients and others with serious illness receive their lifesaving treatment," and, as a result, "puts lives at risk and will mean more cancer patients forced to forgo treatment, live sicker and die sooner."

But wait, there's much more.

As one might have expected given the GOP's relentless war on immigrants, the new law will end healthcare coverage for 27,000 pregnant women and children that even Trump's dreadful "One Big Beautiful Bill Act" specifically allows states to cover. This includes lawful permanent residents with green cards, refugees, asylees, victims of human trafficking, and people granted stays of deportation because they will face torture and persecution if forced to return to their native countries.

The new law also further and unnecessarily toughens already pointless and bureaucratic work requirements by mandating that Medicaid enrollees must have met them for three months before they can gain coverage. A memo prepared by the state Department of Health and Human Services and shared with lawmakers prior to the bill's passage documents how this provision will create all kinds of complicated bureaucratic nightmares and added expense for the counties that administer the program, while saving — get this — exactly zero dollars in state funds. As with the anti-immigrant provisions, this change is even more punitive than the Trump law mandates.

And the list goes on. Repeatedly, the new law establishes cruel roadblocks that will send thousands of North Carolinians who gained health coverage thanks to the state's long overdue 2023 expansion of Medicaid back to hospital emergency rooms again for basic care. In many instances, it's as if the Republican bill authors simply enjoyed playing Scrooge to the state's people in need because they get some kind of perverse, macho kick out of the experience.

And yet, of course, as Gov. Stein would undoubtedly point out, it could have been much worse. When you're dealing with a group of politicians possessed of large partisan majorities and a ready willingness to endanger the healthcare of millions in service of an extreme ideology, a caring and thinking governor does what he can to limit the carnage.