Let's pretend we have a governor—a Republican, let's say. He's trying to decide what to do about Medicaid expansion. It's a crucial issue he knows he's dodged for far too long. Let's also pretend that he understands why it's important.
Pretending, I presume, is what dozens of health-care advocates were doing at the State Capitol recently as they exhorted "the governor" to be a leader.
They came armed with the facts about how much our state is losing by refusing expansion. They pleaded for the working people whose health is jeopardized, working people whose children also suffer when an untreated illness keeps their parents off the job.
"You don't have to be much of a pediatrician to notice" how children get hurt, said Peter Morris, MD, of Raleigh. "Gov. McCrory needs to step up."
But the real Pat McCrory is a coward on Medicaid expansion. Either that, or he's just ignorant. Because there is no reasoned argument for refusing it. But there is a political argument, which is that the Republican base hates Medicaid, hates Obamacare—from which the expansion sprang—and if McCrory doesn't show sufficient hatred, the base might dump him in 2016 for a new right-winger.
What Morris and friends were imagining, then, was a different governor. Let's call him Matt Pickory. A governor with the intestinal fortitude to rise above petty politics—and the brains to see that it would help him politically.
Some data: Medicaid is 50 years old as of last week, as is Medicare. Medicare is health insurance for those over 65 and for some with disabilities, paid for by the federal government. Medicaid is insurance for the very poor; it, too, covers some with disabilities, and many living in nursing homes.
About two-thirds of Medicaid is paid for by the feds; state governments finance the rest. Each state runs its own program.
In North Carolina, Medicaid enrollment totals 1.9 million adults and children. Medicare covers 1.6 million. Thus, more than one-third of the state's residents rely on these two government-run insurance programs.
This, to a Republican ear, is the "socialized medicine" they warned about, or their forebears did, a half-century ago. And to be fair, they're not totally wrong. American health care is a bloated mix of free-market prices—which are sky-high compared to the rest of the industrialized world—and government subsidies. It's a hybrid, and not a good one.
Other industrialized nations have opted for truly socialized health care, where government sets the benefits and the prices. That's what we would have if Medicare or Medicaid covered everyone—but, of course, they don't.
Enter the Affordable Care Act. It requires most not on Medicare or Medicaid to have private insurance, through an employer or by purchasing an individual policy. For middle-class buyers, federal tax credits (more subsidies) are provided. But the credits aren't available to the working poor—folks who make $15,000 or $20,000, for example. Instead, they were added to Medicaid, which was expanded to cover everyone below the income levels at which tax credits kick in.
Or they were supposed to be added. But the U.S. Supreme Court mucked it up, ruling that the ACA is constitutional except for Medicaid expansion. For reasons that defy explanation, the court decided no state could be forced to accept expansion—though it was 100 percent federally funded through 2016 and 90 percent after that. But states either have to accept basic Medicaid, just 65 percent federally funded, or lose a lot of federal dollars.
The ridiculous upshot is that 30 states have the expanded Medicaid, and Utah will likely soon make 31. But 19 red states still reject it, including the old Confederacy. Once again, radical Republicans are waving the bloody shirt.
It's a disgrace.
Without expansion, up to 500,000 low-income North Carolinians, most working in retail or service jobs, are denied the insurance they need, lost in a so-called "coverage gap." The cost to the state's economy is upward of $2.5 billion a year. (Annual spending per N.C. enrollee: About $5,500.) That's an astounding
43,000 new jobs in health care over the next four years that, according to credible experts, we're tossing away.
Listen, right-wingers, I get that you despise government. But as my old man used to say, you are biting off your nose to spite your face. (Actually, the state's nose.) You want people to work, but you penalize them when they do?
So back to our imagined Gov. Pikory. No way he can ever get an expansion bill through the GOP-controlled Legislature, right? Wrong! He doesn't need every Republican, just nine out of 33 in the Senate and 16 out of 75 in the House—because every Democrat should be with him.
Flash that leadership, governor. You can't get nine Republican senators to back you up? You have to try.
Will doing so cost him the '16 Republican primary? Well, he's already a notorious weakling, so any display of guts could only help him against, say, Lt. Gov. Dan Forest. And think, when the general election comes along, he'll be the forceful leader who rose above politics.
The fearless Matt Pikory. Or, if he wasn't such a coward, Pat McCrory.
This article appeared in print with the headline "The fearless Matt Pickory."