North Carolina’s Republican-led legislature last week approved the expansion of Medicaid to more low-income adults, leaving only 10 states that continue to reject the federal government’s incentives under the Affordable Care Act. Medicaid expansion, aimed at adults who make too much money to qualify for conventional Medicaid but not enough to receive subsidized insurance through ACA marketplaces, has had a bigger effect than any other policy in reducing the country’s uninsured population. Expect the last 10 states, most of which are strongly Republican, to eventually sign on, too.
That’s not the way things normally work in this era of partisan polarization, where the nation is moving to two sets of laws, one for Republican states and one for their Democratic counterparts, on many policy questions where the federal government allows choice. We no longer expect California and Texas to converge voluntarily on the same abortion policy or the same rules about labor rights or the same laws about school choice. And yet North Carolina now joins Idaho, Arkansas and several other Republican states in adopting the reform. (1) And it’s just a matter of time before Texas, Florida and the others join in.
The steady adoption of Medicaid expansion has occurred even though the ACA, otherwise known as Obamacare, continues to be unpopular among Republicans. Driving the expansion even in Republican-dominated states is the law’s basic structure, which not only makes Medicaid expansion an excellent deal financially but also creates powerful allies in favor of it.
