Editorial: In Medicaid expansion, both sides must negotiate in good faith

Published 12:00 am Wednesday, July 3, 2019

After Democrats broke the GOP supermajority, Senate Leader Phil Berger at the start of this year’s legislative session offered optimism that bipartisanship would prevail.

Berger said he was “hopeful now that we can put political battles behind us and find common ground in advancing our shared interest in helping North Carolina continue to grow and prosper.”

But that statement seems to closer than ever to a meaningless phrase in a speech following Gov. Roy Cooper’s budget veto last week. Republicans in the legislature on Tuesday issued statements saying, in part, Cooper’s veto would soon create a state of mass confusion.

The budget threatens to “throw the entire transition to managed care into disarray, resulting in mass confusion for the traditional Medicaid population,” Republican Sen. Joyce Krawiec, of Forsyth County, said in a news release.

Cooper is choosing “one policy issue” over teachers and students in the state, stated another news release on Tuesday.

“Unless we are able to override the governor’s veto, no teachers will get raises, the infusion of much-needed capital funding will be deleted and additional school safety measures will be diminished,” said Republican Sens. Deanna Ballard and Jerry Tillman, Senate Appropriations chairs. “I don’t understand how someone who says schools are the ‘backbone’ of our state is willing to jeopardize all of that just to make a political point.”

When Republicans put Cooper’s veto that way, it sounds like a serious mistake. But it remains unclear how Cooper’s veto suddenly cancels teacher raises already in the budget. And in a growing state with a healthy economy, there’s no need to choose between one or the other — schools or health care. That’s particularly true because the federal government would pay 90 percent of the costs for Medicaid expansion — billions of dollars.

A deal where the federal government commits to foot the bill for an overwhelming majority of the costs for hundreds of thousands of people to get covered is hard to pass up. The expansion would raise income criteria to 138% of the poverty line, or $29,400 for a family of three. And with insurance coverage, North Carolinians suddenly have the ability to seek preventative care instead of only seeking treatment when a condition reaches a critical point. Hospitals would have an avenue through which to seek payment for patients who make the tough choice to seek care at an emergency room without a means to pay.

Studies also have repeatedly shown that new jobs would be created as a result of expansion, most of which would be in health care. The latest example is a June 2019 study by George Washington University that estimated 24,000 jobs would be created in 2020, with that number increasing to 37,200 by 2022. Almost half of the job growth would be in the some of the state’s largest counties, the study found.

In an op-ed published last month in the News & Observer, Berger said making “insurance available to more citizens is a lofty ideal” and commended his colleagues for pursuing that goal. But he said expansion would not increase access or result in additional training.

Those are understandable concerns, but opponents should not diminish the impact that the certainty of insurance coverage would mean for hundreds of thousands of North Carolinians.

Legislative leaders included in the budget a provision encouraging Cooper to call a special session on Medicaid expansion, but legislators are not required to come to a decision at the conclusion of any special session.

As other red states have expanded Medicaid under Democratic and Republican governors, North Carolina has avoided following suit. If legislators are to, as Berger committed to at the start of the session, find common ground on the shared goal of helping North Carolina prosper, Republicans and Democrats should take Cooper’s veto as a charge to begin discussions in good faith  and willing to settle for a good instead of perfect.

North Carolina prospers when more of its citizens have health insurance coverage