Today I want to talk about something I just read about North Carolina. But first a little background: I mentioned – only briefly – in my very first post, If You See Something . . . that politics has become increasingly polarized in recent years, but particularly so on the Republican side. I recommended a book that gives an eye-opening analyses of how that’s happened with D.C. Republicans (our national representatives) during the Obama era. But a great example of that on the state level has been happening in North Carolina. North Carolina has been in the news a lot lately, because the Republican legislature and the outgoing Republican Governor, Pat McCrory, have been doing some things that most neutral observers agree have tested the bounds of political decency. Since they’ve been well covered in the news, I won’t rehash them in full detail, but I’ll give a brief overview with some links for more detail for anyone who hasn’t heard what’s been happening there. (If you’re already familiar with the background, or just want the punchline, feel free to skip ahead a few paragraphs . . .)
Governor McCrory narrowly lost his bid for re-election last month to his Democratic challenger Roy Cooper. McCrory spent several weeks afterward trying to challenge the results of the election with baseless claims of voter fraud, but he finally conceded about 2 weeks ago. Soon after, Republicans in the state legislature called a surprise special session.They claimed at first that it was to deal with hurricane relief, but it quickly became clear something more was going on. Eventually it was revealed that – in a shocking move designed to retain as much of their power as possible – the Republican majority was putting together two major bills to significantly limit the powers of the incoming Democratic Governor. Governor McCrory signed both of the bills into law. The enactment of these laws was a glaringly partisan move, and it completely disregarded the will of the voters, who just weeks earlier made clear their choice of Democrat Roy Cooper as their new Governor.
Next up, about a week later, Republicans and Democrats in the state legislature made a deal for the repeal of the very controversial HB2 law, also known as the transgender bathroom law. Democrats agreed that the Charlotte city council would repeal its nondiscrimination ordinance (which had been the impetus for the passage of HB2 at the state level) and in exchange, state Republicans would repeal HB2. Skipping ahead to the end of this little tale, Democrats in Charlotte repealed their ordinance as promised, yet state Republicans failed to repeal HB2. There’s been lots of back and forth between the two sides about what really led to the failure, but the bottom line is the deal was broken and the controversial law still stands.
With that as background, I read something this morning that still managed to make me go “hmmm”. Apparently, while the Republican legislature was putting together the bills that would strip Governor-elect Cooper of much of his power, they took some time out to think up a new perk for outgoing Republican Governor McCrory. They wanted to allow him to stay on the State Health Plan after he left office so that he could receive health coverage for free for the rest of his life.* They would also extend this perk to nine other statewide office holders, such as the Attorney General, Secretary of State, etc. As a side note, members of the North Carolina legislature also get completely free health insurance, even though attending the legislature is a part time job there.
So why did this catch my eye? Because at the same time they’re enjoying their perks and considering adding a new one for Governor McCrory, the members of this legislature (and McCrory himself) have made North Carolina one of only 19 states in the country to refuse to expand Medicaid under the Affordable Care Act (ACA), better known as Obamacare. In explaining why they considered this perk for McCrory, one of the members the State Assembly said:
There was a great deal of empathy for McCrory. He gave it all he could. People ought to help him as much as we could.
This, about a man who, before becoming Governor, was a very successful businessman and will surely have many lucrative opportunities awaiting him upon leaving office. McCrory probably won’t have much difficulty finding and paying for health insurance, but the guy makes him sounds like a starving orphan.
Yet, when it comes to fellow North Carolinians living at or just above poverty levels, this principle of empathy and the desire to help seems to be missing. Under regular Medicaid eligibility in North Carolina, working age adults can only qualify if they have a disability or if their income is less than 44% of the federal poverty level (FPL) and they have dependent children. However, if North Carolina had expanded Medicaid eligibility under the ACA**, adults would qualify for Medicaid if they have incomes up to 138% of FPL. That would be the only requirement – disability, children, etc are not factors. For reference, the 2016 FPL for an individual is $11,880 per year (modified adjusted gross income). So even at 138% of FPL, this generally encompasses people who would have a very hard time finding money to pay for doctors’ appointments or prescriptions, and certainly couldn’t afford care for chronic illnesses or a sudden serious illness or injury. And keep in mind that many of these people are working but don’t make a living wage, or have worked most of their lives and lost jobs during the recession or due to illness and then were never able to get back into the employment cycle.
But due to the decision of the Governor and the legislature in North Carolina not to accept the ACA Medicaid expansion, most of these people are out of luck when it comes to finding health care.*** The numbers vary depending on who’s doing the assessment, but the Medicaid expansion would have added coverage for somewhere in the range of half a million people in North Carolina if the state had accepted it. Instead these people need to rely, for the most part, on emergency room services. And for things that can’t be treated in the ER, they most likely forego treatment entirely (which of course means that many things that could be treated early & simply will eventually turn into costly, emergency situations). In some cases, if they’re lucky, they may be able to get access to a free clinic. There might be arguments to be made against the ACA’s Medicaid expansion, but Governor McCrory and the Republican legislature could have prevented a lot of suffering for their constituents by expanding Medicaid. Given their decision not to do so, it’s pretty galling to see calls for empathy & assistance with health coverage coming from that same legislature, on behalf of the very Governor denying the same compassion to hundreds of thousands of their constituents.
* In the end, because they were so busy racing the clock to pass the bills stripping Governor-elect Cooper of power, they ended up not passing the bill to give McCrory this new perk.
**Under the ACA, the federal government paid 100% of the costs to the states of the Medicaid expansion through 2016. Over the next few years that amount gradually declines until they reach 90% of the costs in 2020, which they will continue to pay going forward.
***People who make 100% of FPL or above (up to 400%) are actually eligible for subsidies to buy health insurance on the ACA exchanges. But unfortunately anyone making below 100% of FPL is not, even if their state does not make them eligible for Medicaid. This is due to a disconnect between the way the law was intended to be implemented and the way the Supreme Court interpreted it in National Federation of Independent Business v Sebelius (the culmination of various challenges to the ACA brought by conservative groups and numerous Republican governors & attorneys general).