EDITORIAL: Message from Va. to NC — expand Medicaid

Nov. 11--North Carolina's Republican state lawmakers studying the results of last Tuesday's elections in Virginia may have realized that even gerrymandering can't protect them from voters fed up with legislation that denies the popular will. After holding a 66-47 majority in Virginia's House of Delegates, Republicans lost 19 seats and could lose a couple more as close races are recounted.

But if gerrymandering isn't a sure protection for Republicans in North Carolina, maybe expanding Medicaid could bolster their chances. It would be an extraordinary move for a very conservative Republican-led General Assembly, but it is the kind of broad and sweeping change Republicans must make if they hope to counter a mounting revolt against legislative actions that have been both hard-hearted and soft-headed. First among those actions was passage of a 2013 law prohibiting the state from accepting billions of federal dollars to provide health insurance for as many as 500,000 North Carolinians.

Clearly Medicaid expansion was a factor in Virginia, where the Republican-led legislature thwarted efforts by Democratic Gov. Terry McAuliffe to expand the program to include 400,000 of the state's poorer residents. But after voters overwhelmingly elected Democrat Ralph Northam to succeed McAuliffe and voted out nearly a score of Republican lawmakers, further resistance to expansion is a path to a Republican minority.

"All the folks who fought me on Medicaid expansion, they all got blown out," McAuliffe said at Northam's victory party. The parting governor plans to put Medicaid expansion in his final budget and he expects Northam will be able to push it through.

Action in other states

The message on Medicaid wasn't limited to Virginia. Voters in Maine, frustrated by Gov. Paul LePage's five vetoes of Medicaid expansion legislation, approved expansion through a ballot initiative that is not subject to veto. In Idaho and Utah, groups are working to get similar initiatives on the 2018 ballot.

North Carolina voters do not have the option of putting Medicaid expansion on the ballot, but they do have the option of voting against Republican lawmakers who oppose it. Medicaid expansion has broad support in North Carolina. A national poll in April found 66 percent of North Carolina respondents favored expanding the state's program.

General Assembly Republicans have never made a strong case for foregoing federal funds provided under the Affordable Care Act for expanding state Medicaid programs. They've said the state program was too poorly managed to be given more funding, but reviews have found the program to be well run and even performing under budget. Now Republicans say that although the federal government will pay for 90 percent of the expansion, the state shouldn't take on the 10 percent cost.

The numbers show the profligate expense of what Republicans are trying to cast as prudent. The 10-year expense to North Carolina to expand Medicaid programs from 2013 to 2022 would have been $3.07 billion, about $300 million a year, according to a 2014 report from the Urban Institute. The gain to North Carolina over that period would have been $39.6 billion in federal Medicaid funding plus $11.3 billion in hospital reimbursement funds.

Resisting Obama

The actual reason for resistance is as clear as a map of holdout states. Only 18 are still refusing to expand and they are centered in the South where resistance to President Obama was strongest. But refusing to engage with what they call "Obamacare" becomes increasingly pointless the longer Obama is gone from office. In North Carolina, resistance to a past president may cost Republicans their present majority.

That message has been sent by voters in Virginia and Maine and it's being picked up by voters in other holdout states. In Kansas, the Republican-led legislature voted this year to expand Medicaid, but the bill was vetoed by Gov. Sam Brownback. Brownback is awaiting confirmation to an ambassador-at-large position in the Trump administration, but Lt. Gov. Jeff Colyer, who would replace Brownback, is also against expansion.

That's a politically dangerous position to maintain, said David Jordan, who leads the Alliance for a Healthy Kansas, an advocacy group. He told The New York Times after the Tuesday elections, "Yesterday's results in Virginia and Maine should send a message to (Colyer). It could become really tough to go against this wave."

North Carolina is closer to Virginia than Kansas is. It should hear the message all the more clearly.

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