NC should turn its eyes to Kentucky

by Marian and Tom Sink, guest editorialists, The Asheville Citizen-Times, July 24, 2015.

In 2011 our North Carolina Legislature refused to expand Medicaid to cover more of North Carolina’s “working poor” citizens under the Affordable Care Act enacted by Congress and signed into law by President Obama in 2010. As we all remember, in 2011 the political atmosphere surrounding the Affordable Care Act was absolutely “toxic” and our Republican controlled legislature was simply incapable of seeing any benefit from any part of the hated “Obamacare” law.

However, certain Republican-controlled legislatures (notably, Kentucky) did elect to expand Medicaid pursuant to the Affordable Care Act — while others, including Tennessee (like North Carolina) refused.

Here are some of the outcomes:

1. At no cost to its state treasury through 2017 (and a 5 percent cost in 2018 that gradually increases to 10 percent by 2020), Kentucky secured medical coverage for more than 300,000 Kentuckians — almost all of whom were “working poor” earning too much to qualify for Medicaid under the original guidelines — but not earning enough to afford medical insurance. Kentucky’s expansion of Medicaid provides more than 300,000 Kentuckians with access to medical care.

2. By contrast, the Council of Economic Advisors estimates Tennessee has about 5,200 deaths per year that might have been avoided if the Tennessee Legislature had expanded Medicaid. Results in North Carolina are doubtless similar.

3. Kentucky estimates 40,000 new jobs have been created by its decision to expand Medicaid.

4. Kentucky hospitals have received about $506 million more in additional Medicaid payments than they would have in the absence of Medicaid expansion.

5. Meanwhile, North Carolina and Tennessee taxpayers continue to pay federal taxes that underwrite the outcomes in Kentucky — and other states that expanded Medicaid — while we receive absolutely no benefit.

The Affordable Care Act has now survived two Supreme Court challenges and more than 50 “repeal” votes in Congress. As a practical matter, the 50 “repeal” votes were nothing more than political theater because, under Senate rules, a 60 vote “super” majority is needed.

Since 2013, tens of millions have secured health care insurance, many with subsidies, by enrolling at the Healthcare.gov website and state health care exchanges. The Affordable Care Act has had a lower cost than predicted and has reduced our federal deficit. Clearly, the Affordable Care Act is the law of the land and will not be repealed, regardless of who is elected president in 2016.

We understand expansion of Medicaid by North Carolina would cover only “working poor” individuals and families — and would directly enable about 140,000 children to receive full access to medical care that they presently get now only if they become sick and parents take them to an emergency room. This “emergency room option” for medical service delivery is both wasteful and inefficient — and it is a financial drain on our hospitals, which must provide medical services to poor people who come to their emergency rooms but have no prospect of paying for such services.

Our N.C. legislature and Gov. McCrory need to consider the experience of Kentucky and other states that expanded Medicaid under the Affordable Care Act, and then revisit the question of whether N.C. should expand it. The excuse given by legislators in 2011 was that N.C. needed to “fix” Medicaid before we expanded it. Despite inaction by our Legislature, Medicaid still works in North Carolina! We should expand Medicaid, as authorized by the Affordable Care Act, to cover more of the “working poor.”

Marian and Tom Sinks live in Black Mountain.