Alexander H. Jones: The right’s lonely war against Medicaid expansion is doomed

Published 12:00 am Wednesday, June 29, 2022

A dream so long enjoyed cannot cease without hardship. But the psychological pain of diminishing hope seems to weigh heavily on the minds of North Carolina’s political Right. For the myriad operatives of our state’s organized right wing movement, the rising likelihood of Medicaid expansion is causing something akin to panic. For those who have long taken pride in obstinate rejectionism, an existential crisis is setting in at the prospect of making healthcare more affordable to the needy.

The panic is palpable, for example, in the tone of the Art Pope-John Locke Foundation’s various outlets, which are taking an increasingly desperate tone when inveighing against Medicaid expansion. The same old stale arguments against expansion that opponents have levied over the last decade have collapsed one by one under the weight of observable reality, as have been attempts to portray Medicaid expansion as a policy blunder. After all, 38 U.S. states, plus the District of Columbia, have successfully expanded Medicaid, and not a single one has subsequently chosen to reverse course. Indeed, several have pushed further yet. Yet expanding access to affordable healthcare to millions, as Medicaid expansion would do, is an unqualified policy failure for those so wedded to ideological purity that they have lost their sense for what is right.
Economists like to talk about revealed preferences – meaning, what people actually do, as opposed to what they say? On this note, the obvious satisfaction with Medicaid expansion among states that have adopted it is all we need to know. Even ruby-red states like West Virginia and Ohio pleaded with the Republican Congress not to jettison expansion when GOP leaders belatedly drafted an Obamacare “repeal” bill. (Which, of course, they were unable to pass.) In Kentucky, one of the reddest states in the country, a Democrat won the governorship in large part by running as the defender of Medicaid expansion. In nearly every state, Medicaid expansion has been, to quote North Carolinian Phil Berger, “a slam dunk.” Or, at least, it has been beneficial enough that Republican representatives are willing to fight their own party to preserve the funding for public insurance.
For the most rigidly ideological opponents of affordable healthcare, their real opponent is obvious: President Barack Obama. While the rest of the country has moved on from battles over the Affordable Care Act (a.k.a. “Obamacare”) and takes steps to insure their people, bitter ideologues – comfortable in their cool offices and generous private healthcare plans — are still dedicated to cutting off their nose to spite their face. Years after President Obama left office for a well-deserved retirement, they still want to deny him an imagined victory. You can even detect a theme of good old-fashioned Lost Cause-ism in their quixotic quest to block healthcare to needy North Carolinians.
Thus, once again, North Carolina’s extremist-right stands alone. In the North Carolina State House, a stubborn band of hardliners harboring strange politics refuses to join everyone else in the sunshine of compassion. The fiscal case for Medicaid expansion is inarguable. The moral case is open and shut. But the most pathologically ideological conservatives are undeterred, either by the debunking of their policy arguments or by the isolation of their cause.
Alexander H. Jones is a policy analyst with Carolina Forward. He lives in Chapel Hill. Have feedback? Reach him at