EDITORIAL: Now is the time … expand Medicaid

Feb. 17--Gov. Roy Cooper has done his part to forge a reasonable compromise on expanding Medicaid in North Carolina. Now the Republican-controlled General Assembly should be willing to bend a little and help get Medicaid coverage for an estimated 400,000 to 500,000 additional people.

Our political system is designed to work on compromise, but compromise has been in short supply lately. In North Carolina, Republicans control the legislature, and their dealings with Democratic Gov. Roy Cooper have mostly had something to do with reducing his power.

Cooper, for his part, finds little on which to agree with Republicans. Often, it's the state's people who suffer.

Medicaid expansion has been a particularly divisive issue because it originated with the Affordable Care Act, aka Obamacare, and opposition to all things related to Obamacare has been a Republican tenet from the outset. When the federal government offered the possibility of Medicaid expansion, 33 states accepted it.

North Carolina was one of those states that declined, even though most of the cost would have been borne by the federal government, and even though covering more people would have helped them, hospitals and underserved rural areas. A number of Republican governors, including Mike Pence of Indiana -- now the vice president -- saw the advantages and accepted the expansion. Not the Republicans in the North Carolina legislature, however.

But in January, Cooper's administration took the unusual step of asking permission from the federal government to add a work requirement as part of Medicaid expansion here. And now the Trump administration has given its OK to North Carolina and other states that have requested a waiver to Medicaid rules that would allow them to add a requirement for work or "community engagement."

But despite Cooper's move, and even though four state House Republicans filed a bill last year to expand Medicaid, focusing on the insurance aspects and including a work requirement, Republican leaders don't seem to have the issue on their priority list.

Cooper's action is a welcome sign of flexibility and a willingness to put the good of the state ahead of partisan battles. Attaching a work requirement to Medicaid is something many liberals -- many of them Cooper supporters -- strongly oppose.

The idea that people can choose not to work yet get free health coverage is a political rallying cry on the right.

Those on the left believe it's wrong to make people with legitimate problems -- those who are physically or mentally unable to work, or who cannot get adequate child care, or who simply can't find employment -- to get a job or have no health coverage.

In this case, the proposed requirement seems to have adequate safeguards. People enrolling in Medicaid would be required to be employed or to be participating in activities such as training or volunteer programs that might help them find jobs.

There would be numerous exemptions, including people with disabilities, pregnant women, children and the elderly. Many of those who would be covered in the expansion are the "working poor" who already have jobs but no health insurance.

There are legitimate concerns about the pitfalls of such a requirement, including additional red tape and bureaucratic cost, and making sure the federal government keeps its promise to pick up most of the cost. Employers might need to be willing to hire more people who have disabilities but are able to work.

But all in all, this sounds like the best kind of compromise, one that would do a lot more good than harm, from either political perspective. Cooper's first step gives Republican leaders a chance to expand Medicaid to some 500,000 North Carolinians without riling their political base.

They should take advantage of the opportunity.

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