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’ll be so sad if Obama wins the nomination this year, because of the way he’s run. Clinton has criticized him, but never his supporters. He basically denounces anybody who supports anyone else.
We’re either corrupt (that’s for bigwigs, and his code for it is that they’re part of “business as usual”) or we’re relics, pessimists, fuddy duddies who want to live in the past (a place where apparently there were a lot of female Presidents I don’t know about), opponents of change, unworthy of his Brave New World.
All it takes to turn a bad person into a good person in Obama’s book is transferring allegiance from Hillary to himself, sufficiently early. After the convention — morally, not practically, speaking — is too late. Ted Kennedy, who has been a Senator for 46 years, and even collaborated with George Bush, isn’t part of “business as usual.” Why? He supports Obama now. And that is the only reason.
Having to support a nominee who has done nothing but diss me all these months will be painful. I’ll do it, if I have to, but I still hope I won’t have to. I have hoped so hard to feel a part of the next Democratic administration, but it seems to me that the “uniter” Obama has told me pretty clearly I’m not the stuff he wants his new America to be made of.
He’ll take my vote, of course, and let me try and make it up to him that I ever supported Hillary Clinton. But basically I’ve marked myself with him as not quite up to snuff, and even if he might have some use for me, his respect I’ll never ever have.
Nor will I have the respect of Obama’s most earnest supporters on the Net, that is abundantly plain. I, who would support any Democratic nominee over any Republican this year, am as bad as any Republican to people who declare they’ll sit the election out or vote for John McCain if Democratic voters have the temerity to deny the nomination to Obama. I’ve failed to recognize his Destiny, and woe to any of us who do not acknowledge our newborn king.
Hillary was supposed to be the divisive one, but she’ll be lovely to former Obama supporters if she gets the nomination. Obama has divided the party into good and bad Democrats. Paul Krugman and Charlie Rangel and I belong to the latter category.
The oh-so-junior Senator from Illinois hates us even worse than he hates Dick Cheney. A Republican for Obama, no matter what eles he believes, is cherished proof of the candidate’s charisma. A Democrat for anybody else, even if he takes the same position on every issue as Barack, proves only his own perfidy.