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.
ditto on what DC in CA said. I am doing phonebanking to the swing states and planning to do GOTV during the days before the election. I am glad the numbers are looking good- but shouldn’t we be focused on making them even better?
Splendid news! Let’s just hope (and pray-) that the crucial third debate goes as well as the first two did.
BTW, what kind of “message” do you think Kerry should send to undecided voters in the debate? (I assume there will be some sort of closing statement again). Off the top of my head —
1) He should promise to be a “uniter” by solemnly pointing out the U.S. is at war and Congress likely will remain in Republican hands. He should hint that this might mean compromises on spending priorities, so that at least the deficits could be reduced. I think many fiscal conservatives and independents would like this.
2) He might touch the cultural issue (the red wine, fluent french, his windsurfing hobby etc.) and beg culturally conservative voters not to dismiss him out of hand if they agree with his economic policies.
3) He should point out that his opponent has expressed his unwavering determination to continue the same policies for another four years, if re-elected. In other words, the current policies in the Middle East will continue to be pursued and the handling of the federal economy won’t change. He should ask voters who think they were better off in 2000 to take a chance on him. I think it is a very powerful argument, since “Shrub” and his followers are strugging to portray 2001-04 in a positive light and mostly duck the issue altogether.
4) He should defuse the extremely silly “global test” smear/scare campaign by explaining that it is merely a common sense term for saving American lives and dollars before going to war. In 1991, the other Gulf states largely reimbursed the U.S. for the cost of Gulf War I. Not so this time.
5) Debate tactics. In the first debate, he was polite, well informed and surprisingly clear and succinct. More of the same, please! I would also like to see him damn the president with faint praise by first agreeing with the conventional wisdom that “Shrub” is a decent man who does what he thinks is best of the country. Having said that, he should then gently question whether “Shrub” really is qualified for the job, in the light of this Administration’s numerous screw-ups at home as well as abroad. “Grand vision” alone is not enough, he should say — the U.S. now needs competent management to turn Iraq and the federal economy around. It’s a very powerful argument. Saying “Shrub” is an immoral liar won’t work. Saying he simply isn’t up to the task of running the country just might work, since there is ample evidence for it.
These are all nothing more than a good start.
Yes, they are a very good and encouraging start, but let us all do what we can to keep those trend lines going.
A good start. Now let’s do what we can – canvassing, phone banking, and other GOTV activities – to make for a great finish.
Nice Cherrypicking, but here’s a few you forgot. Btw, ARG = Kerry’s Private Poll.
Marist: Bush 49, Kerry 46, Nader 1
Reuters/Zogby Tracking Poll: Bush 46, Kerry 44, Nader 2
Florida: Quinnipiac: Bush 51, Kerry 44
Pennsylvania: Bush 47% Kerry 47%
Colorado: Bush 48% Kerry 44%
Michigan: Bush 46% Kerry 46%
Virginia: Bush 50% Kerry 44%
I think tide is turning. After the debates, GW will finally be exposed as being way over his head as president. (if not already) I’m still one of those who think the race will be a route for Kerry, similar to Reagan over Carter in 1980