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.
I think Kerry is in a great position to surge ahead based on such things as:
A strong debate performance
An uprising in Iraq going beyond the present upsurge
A North Korean bomb test if he can convincingly make the case that it is due to Bush fumbles.
My dream result is:
*Kerry wins big, bigger than any thought
*The pro Bush polls are exposed and ridiculed
*The good polls are vindicated by being closest
From Zogby’s notes for the survey: “Slight weights were added to region, party, age, race, religion and gender to more accurately reflect the voting population. Margins of error are higher in sub-groups.”
As noted by others in previous posts, Zogby and some others are weighting party ID a little bit in their polls, while Time, Newsweek, etc. aren’t. I didn’t see in the notes to this poll what the exact weighting for Dems/Reps/Inds was.
This whole debate over whether to weight party ID or not is starting to get a little play in some of the media – the local NPR station in NY had a segment on it yesterday. Here’s an off-the-cuff observation: one would think that there would be some sort of established standards for an industry that’s been around for many decades. If a pollster is going to weight other factors, why would he/she exclude party ID from (at least to some extent) the same treatment? The arguments that I’ve heard that party ID should be a “floating variable” don’t make much sense if every other major demographic attribute gets weighted. One can sum up these polls with this motto: buyer beware – read the fine print.
In any event, the numbers are starting to settle in the wake of the GOP hatefest. It looks like Bush has established a 2-4 point lead. Kerry still has the issues environment on his side, so I remain optimistic that we’re going to win. BTW, Jeff’s post from yesterday about the demographic changes in the electorate over the past four years was great…I was aware of nearly all of those things, but he put all the pertinent data in a summarized and understandable format.
This contributes little to the discussion of facts, but…let me say what a good pick-me-up your blog is, Ruy. For those of us who care deeply about this election and its repercussions (but haven’t the time to parse the details), I count myself fortunate to be able to visit your site and routinely catch “the rest of the story.” Believe me, I pass it on to all my Donkey friends.