THE issue of the 2019 session
The 2019 session of the North Carolina General Assembly gets underway in earnest this week in Raleigh and, as always, dozens of important issues will compete for lawmakers’ attention.
There’s the increasingly energetic and promising effort to end partisan gerrymandering, the desperate need to adequately fund our public schools and bring accountability to vouchers and charters, the mushrooming environmental crisis that continues to unfold in myriad guises, the chaos that has gripped the UNC system, and, of course, our desperately out-of-whack tax system that increasingly favors the rich and large corporations at the expense of essential public services and structures that make a middle class society possible. Many other issues that will at some point lead to passionate debate are still gestating in the minds of lawmakers, lobbyists and bill drafters.
If those who truly care about the present and future wellbeing of 10 million North Carolinians were forced, however, to pick a single issue that will ultimately go the furthest toward determining the success or failure of this year’s legislative session, one clearly stands out: Medicaid and its long and desperately overdue expansion under the terms of the Affordable Care Act.
Think about it. North Carolina has gone for half of a decade now in the national backwaters – stubbornly refusing to take action that the overwhelming majority of states, under political leaders from both major political parties, have taken. This inaction has, quite literally, cost thousands of human lives and tens of billions of dollars that could have been injected into the state’s economy.
At the start of 2019, however, there is reason to believe this situation can finally change. Multiple Republican lawmakers, like their compatriots in several other states, are putting ideology aside and stepping up to the plate to take the life-saving action that they know is morally and fiscally correct.
We saw this during the last General Assembly, when Republican House members advanced the significantly flawed but promising “Carolina Cares” proposal, and we’ve seen it in recent weeks as reports have filtered in from the General Assembly that members of both parties will advance new expansion legislation this year.
One small thing that can be said about the destructive delay that legislative inaction has brought about in recent years is that it has enabled us to learn just what has and hasn’t worked with Medicaid expansion in other states. In this vein, there are two things we can say for sure:
#1 – In general, Medicaid expansion has worked wonders. In state after state, the number of low-income people on the uninsured rolls has dropped dramatically. Late last summer, for instance, the state of Ohio put out a report which showed that in 2008, 36.1% of low income Ohioans, age 19-64, were uninsured. By 2017, that number had fallen to 12.6%. The uninsured rate for all adults had fallen essentially by half. Similar results have been achieved in other states.
#2 – States need to be extremely careful when attaching mandatory work requirements to their Medicaid expansion laws. Recent analysis of the expansion program in Arkansas found that since the state implemented a strict work requirement last June (certain Arkansas program recipients are required to report at least 80 hours of work or work-like activities each month or risk losing coverage), 18,000-plus people (about half the total expansion population) have lost their Medicaid benefit. What’s more, the Center on Budget and Policy priorities reports that “at most a few hundred people may have found jobs” due to the requirement.
Happily, North Carolina lawmakers have a new opportunity in 2019 to enact and implement a “clean” Medicaid expansion as has been done in most other states.
And if they need any additional evidence of the dramatic difference that Medicaid expansion can make on the lives of real people, they would do well to check out an event that will be taking place this week near the Virginia-North Carolina border at Rockingham County Community College in Reidsville, NC. The event, entitled “A Tale of Two States,” will feature doctors, patient and community advocates (including Reidsville Mayor Jay Donecker) from both states who will describe the stark, real world difference that confronts low income people on either side of the border now that Virginia has expanded its Medicaid program.
Their central message: The lives and prospects of thousands of similarly situated neighbors are vastly different simply because of North Carolina’s failure on this single issue. People who live just north of the border are seeing a brighter future, with less fear and uncertainty and more freedom and health than those who live on the south side.
Let’s hope Senate president Pro Tem Phil Berger, who represents the area in Raleigh, is among those paying close attention.
For those who can’t make it to Reidsville, the event will be “broadcast” live and recorded for later viewing on the North Carolina Justice Center’s Facebook page. Be sure to check it out.
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