There’s another turn in a story we’ve all been following for over a decade, so I wrote it up at New York:
The Affordable Care Act was signed into law 13 years ago, and the Medicaid expansion that was central to the law still hasn’t been implemented in all 50 states. But we are seeing steady, if extremely slow, progress in the effort to give people who can’t afford private insurance but don’t qualify for traditional Medicaid access to crucial health services. The U.S. Supreme Court case that upheld the ACA also made Medicaid expansion optional for states. Twenty-four states accepted the expansion when it became fully available at the beginning of 2014, and that number has steadily expanded, with the most recent burst of forward momentum coming from ballot initiatives in red states like Missouri, Nebraska, Oklahoma, South Dakota, and Utah. Now a 40th state is in the process of climbing on board: North Carolina. As the Associated Press reports, legislation is finally headed toward the desk of Governor Roy Cooper:
“A Medicaid expansion deal in North Carolina received final legislative approval on Thursday, capping a decade of debate over whether the closely politically divided state should accept the federal government’s coverage for hundreds of thousands of low-income adults. …
“When Democratic Gov. Roy Cooper, a longtime expansion advocate, signs the bill, it should leave 10 states in the U.S. that haven’t adopted expansion. North Carolina has 2.9 million enrollees in traditional Medicaid coverage. Advocates have estimated that expansion could help 600,000 adults.”
So what changed? Basically, over time the fiscal arguments North Carolina Republicans used to oppose the expansion began sounding increasingly ridiculous, AP suggests:
“GOP legislators passed a law in 2013 specifically preventing a governor’s administration from seeking expansion without express approval by the General Assembly. But interest in expansion grew over the past year as lawmakers concluded that Congress was neither likely to repeal the law nor raise the low 10% state match that coverage requires.
“A financial sweetener contained in a COVID-19 recovery law means North Carolina also would get an estimated extra $1.75 billion in cash over two years if it expands Medicaid. Legislators hope to use much of that money on mental health services.”
In other words, the GOP Cassandras warning that the wily Democrats would cut funding for the expansion in Congress once states were hooked turned out to be absolutely wrong. Indeed, the very sweet deal offered in the original legislation got even sweeter thanks to the above-mentioned COVID legislation. States like North Carolina appeared to be leaving very good money on the table for no apparent reason other than partisanship, seasoned with some conservative hostility toward potential beneficiaries. In this case, GOP legislators finally reversed course without much excuse-making. The AP reports:
“A turning point came last May when Senate leader Phil Berger, a longtime expansion opponent, publicly explained his reversal, which was based largely on fiscal terms.
“In a news conference, Berger also described the situation faced by a single mother who didn’t make enough money to cover insurance for both her and her children, which he said meant that she would either end up in the emergency room or not get care. Expansion covers people who make too much money for conventional Medicaid but not enough to benefit from heavily subsidized private insurance.
“’We need coverage in North Carolina for the working poor,’ Berger said at the time.”
That, of course, has been true all along. Final legislative approval of the expansion was delayed for a while due to an unrelated dispute over health-facility regulations. And the expansion cannot proceed until a state budget is passed. But it’s finally looking good for Medicaid expansion in a place where Democrats and Republicans are bitterly at odds on a wide range of issues.
There remain ten states that have not yet expanded Medicaid; eight are Republican “trifecta” states (Alabama, Florida, Georgia, Mississippi, South Carolina, Tennessee, Texas, and Wyoming) and two others have Republican-controlled legislatures (Kansas and Wisconsin). Perhaps the peculiar mix of stupidity and malice that keeps state lawmakers from using the money made available to them by Washington to help their own people will abate elsewhere soon.
Kerry needs to discuss the Bush administration’s inept response to information that was given to them before 9/11 concerning terrorist activity in the US. People need to understand that “our great protector” and his administration was given information about possible terrorist plots (ie plane hijackings) and they failed to act on the information! How can someone look at Bush in the same positive light knowing that he failed us back in 2001? And then, he was initially against the Homeland Security Department. Security is a BIG concern in this election. I see nothing that indicates to me that Bush has made us more secure. Another thing, most people I know, regardless of political affiliation, are not happy with the way things are going. People are stressed out! Kerry needs to speak to these people. There are a lot of us. Life is difficult anymore and there is no empathy coming from the Whitehouse. Kerry needs to address this.
Joe
Dan,
I think you are correct on the media buying. I have said this before and will repeat – in the final analysis many folks will not be able to pull the B/C lever or whatever method of voting available. I suspect you need to select one or two polls and stick with them while filtering out the others.
Who are the Republican pollsters and who are the Democratic? I subscribe to Rasmussen and also follow Zogby. I was a Zogby junkie in 00. I have regaining confidence.
There is an arrogance about the B/C crowd. Also things are looking mighty grim in Iraq.
Jody
If you look at the states that K-E are not buying media in at this time, they are all competitive Senate races, except Arizona. If Demos want to allow the Senate candidates to establish themselves you cut down on K-E buys in September, pour money into the Senate race and then buy in October when B-C is buying and the K-E ads do not tie the Senate candidate to the national ticket.
Arizona is a special case because any early push there provokes a McCain response. In October that will not be as big a problem as McCain will be busy supporting the Arizona down ticket candidates.
In other words, there is a rationale that shows careful planning and not hysteria. I have been growing in my confidence that K-E do think through what they do.
Yet listening to Juan Williams on NPR this morning you would think the Kerry is ready to concede Missouri. Really, what the heck are we going to do with the mainstream media. What is with NPR?
Well, all I can say is “figures don’t lie, but liars figure.” I have seen the Gallup guy on TV with his so called groups. I saw a biased republican partisan. And the media is just as bad. So why should I believe the polls when I no longer believe the media. It was just tooooooooooo convenient.
From Missouri—-
I am seeing support for K/E in places where you should not expect it, given the demographics.
Missouri is winnable although it will be close. B/C are taking it for granted. It’s critical to get Edwards in key outstate areas to hold down the GOP vote and Kerry is needed in StL and KC, especially in the labor-oriented suburbs.
Please don’t give up on us. Strategic media buys in October can be critical, especially when the Cardinals are in the World Series.
This is the first time that I’ve been to this site, and I find it far better than the others. I did some research os SurveyUSA on their website.
The good news is that they are usually pretty accurate in their pre-election predictions. The bad news is that they usually, but not always, err on the side of the Democrats.
I also find it interesting that Bush went down in Newsweek but up in Time. Zogby stayed the same; Rasmussen is back to 1 point. Do the pollsters really know what they are doing or is it possible that there are more undecided voters than is commonly believed?
I want my W.rong For America! T-shirt and bumperstickers!
Kerry people are you listening??
I agree. Don’t give up on Missouri or other states in middle America. Independents and moderate to conservative Dems are looking for a reason, any reason to vote for Kerry. They don’t like Bush, but they remain undecided after the Repub convention. Maybe put together a commercial showing Kerry skeet shooting and talking about his joy of hunting. Is Carville on top of this? It works!
Reports are that Kerry’s campaign has pulled all advertising from MO. This now seems terminally dumb if this poll is even close to correct. Gore pulled out of Ohio assuming he was way behind when in fact he was closing. How do we keep Kerry’s folks from premature surrender in key battlegrounds like this? T.J.
Ruy, what is your opinion on SUSA’s methodology? They seem to have as good a record as anyone else based on past elections, but the Hotline for one has a real problem with them and won’t include their results (or Rasmussen’s, for that matter) in their polling summaries.