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.
Governor Crist probably did as well as he could with the political cards that he was holding, but progressives shouldn’t be fooled into thinking that most of those 950,000 ex-felons will have their rights restored any time soon.
Before they get their rights to vote back, they have to pay what was described in the NYT as “restitution.” This sounds like compensation for the victims, but it probably is a short hand for all court costs, fines, and victim restitution that the court has ordered.
At the moment, we have a similar law here in Washington, with the result that most ex-felons have not had their voting rights restored. That is because when they are discharged they often can get only low wage jobs and can’t pay off the court ordered financial obligations, which continue to increase because of interest. In effect, this requirement is a de facto poll tax. Even when they have paid their court ordered costs, there are numerous bureaucratic hurdles to get their status recognized by the state so that they can legally vote. Ex-felons in Florida are likely to face the same bureaucratic hurdles which will delay restoration of the voting rights of most or at least many.
The message is that Crist has taken a good step, but progressives should monitor the implementation process closely and speak up strongly if it turns out that actual progress in restoring voting rights is glacial. Progressives should continue to pressure Florida to adopt a system like that in place in other states, e.g. when you serve your prison time and parole time you can vote. We all have an interest in seeing ex-felons integrated into society. It is hard enough for them without the state taking pains to point out(by denying their right to vote) that they aren’t full citizens.
The post says that Crist “approved a measure.” Was this a statute or other measure that required approval of the GOP Legislature? If so, whatever got them to approve such a politically disadvantageous move? If it was something Crist could do on his own, any info on what pressures he was under from his party not to do it, and why he did it anyway?