North Carolina is seeing a dramatic example of political climate change: Its long frozen opposition to Medicaid expansion is beginning to thaw.
But unlike polar ice sheets ominously sliding into the sea, it’s a good thing that Republican lawmakers are warming to this lifesaving opportunity. It’s also a chance to stop passing up federal money. By failing to expand Medicaid from 2013 to 2022 North Carolina has forgone about $40 billion in federal Medicaid funding, according to the Urban Institute.
State Senate leader Phil Berger, long an opponent of expansion, now says he will consider it. A joint House and Senate committee is assessing a potential expansion’s costs and benefits. A bill setting the terms for making more than half a million North Carolinians eligible for the state and federal health insurance program is expected to get a vote before the November election.
In North Carolina, most adults without minor children or who are not disabled are not eligible for Medicaid no matter how low their income. Expansion would allow the enrollment of all adults earning up to 138% of the federal poverty line – $17,774 a year. That would provide health insurance for many of the state’s working poor.
The prospect of expanding Medicaid has come up before only to fade in the face of opposition in the Republican-controlled General Assembly. But it would be politically dangerous to reject it now. Polls show strong support for expansion in North Carolina and holdout states are increasingly isolated. Thirty-eight states have expanded Medicaid under the Affordable Care Act. South Dakota voters will decide in November whether their state should become the 39th.
Medicaid expansion has long been a deal too good to refuse, but provisions of the American Rescue Plan Act of 2021 make it even better. If North Carolina expands Medicaid, the federal government will increase its payments for the state’s current Medicaid population by 5% for two years. That would be worth about $1.7 billion to North Carolina.
Care4Carolina, a coalition of health care organizations, economic development groups and advocates for patients and families, has pushed in vain for Medicaid expansion since 2015. Now Erica Palmer Smith, the coalition’s executive director, said the impasse may end. “I do believe we will see a North Carolina solution put forward and voted on in this legislative session,” she told the Editorial Board.
The sticking point is the state House. Republican conservatives there see providing health insurance as a handout that should come with a work requirement, a restriction that the Biden administration won’t allow.
Leighton Ku, a George Washington University professor of health policy who has researched the benefits of expanding Medicaid in North Carolina, said it’s a misconception to see extending the program as giving money to the poor. “When you give somebody Medicaid, they don’t become richer,” he said. “You’re just providing medical care for them.”
Some Republicans also worry that adding hundreds of thousands of people to Medicaid could burden the state should the federal government lower its 90% share of the extra costs. But the federal share is part of federal law. To lower it, members of Congress would have to vote to reduce payments to their own states.
In the near term, North Carolina would actually save money because the American Rescue Plan’s boost in current federal Medicaid funding would be greater than what the state would pay for expansion. Ku estimates the savings at $341 million. In addition, he said, expansion would create about 83,000 jobs in the state, about half in health care and half in other sectors.
The Affordable Care Act — along with its provisions for Medicaid expansion — now has the support of most Americans. It’s not going away. Meanwhile, multiple studies have shown that providing more low-income people access to health care has improved the treatment of chronic conditions and reduced cancer deaths and infant mortality.
For years, North Carolina has turned away billions of dollars in federal health care aid, and the cost has been more than money. People have suffered and died unnecessarily because they lacked access to treatments that Medicaid would have provided.
It’s time for North Carolina to expand Medicaid.
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