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.
One last point. We tend to hold it as gospel truth that once in power, a party can no longer motivate its base by attacking the opposition. That attitude is all myth and no substance. We may not be able to attack Bush as directly now as we did back then, but we can, and should, ruthlessly, attack the Republicans in Congress who are doing their damnedest to block everything President Obama wants to do for America.
We took Congress in 2006 largely by attacking Republicans and their policies, and we won the White House in 2008 again largely by attacking Republicans and their policies. Are today’s Republicans any different than the Republicans we attacked last year? You’re darned right they’re not. We either persistently attack Republicans as the problem they continue to be, or risk that voters will conclude that Republicans have somehow ceased to be the problem, and start thinking that maybe we Democrats have become the problem. The best way to ensure that voters don’t make that mistake is to campaign against the Republicans with the same strategies, tactics and aggressiveness that worked so well for us in 2006 and 2008.
An Obama team and Democratic Party that was so successful in 2008 should not have to struggle to win races like this one in Massachusetts.
Yes, health care, jobs and other legislative initiatives are important, but considering that we can only do as much as we’re strong enough to do, elections need to be equally important.
Losing the Governorships in New Jersey and Virginia should have been enough of a wake-up call for our Party leaders. The possibility of losing our 60 seat Senate majority next week should be the last call they should need.
Obama was a community organizer. We broke all kinds of records in voter registration and GOTV in 2008. It’s time that our entire Party, from our Leaders down to our lowliest bloggers understood that in order to do what we want to do, we need to be in campaign mode all year, every year.
I hope we’re wise enough to spend at least as much time and attention between now and November plotting exactly how we will win more seats in the House and Senate (which, contrary to what too many of even our pundits are saying is quite possible), than we spend immersed in long legislative battles like health care and the upcoming jobs push.
The best way to get an unmotivated base energized is to put us to work. I hope our party leaders start doing that soon, at least with regard to our most dedicated members, so that come November we can focus more on winning than on not losing.