By Chris Fitzsimon, NC Policy Watch
One of the biggest decisions facing the new General Assembly and Governor Pat McCrory this year is whether or not North Carolina will expand Medicaid under the Affordable Care Act and provide health coverage for more than 500,000 low income people in the state.
The federal government will pay the full cost of the expansion for the first three years and 90 percent after that. It is a testament to the current political climate that there's even a debate about accepting federal funding to extend basic health care coverage to half a million people who are unable to afford it.
But a debate there is, and a fierce one, with the forces on the Tea Party Right demanding that McCrory and state lawmakers turn down the chance to help 500,000 people who can't afford to see a doctor.
Much of the opposition is more about ideology than anything else, a visceral reaction to a law that has been mischaracterized since it was proposed.
The head of Raleigh's leading conservative foundation, now the de facto staff of the McCrory Administration, argued against the expansion recently and described Medicaid as a "fiscal black hole" of state government, wasting money that could be used to cut taxes or pay for other things.
That's an odd way to describe a program that provides health care services to the most vulnerable people in the state. The vast majority of current Medicaid spending pays for care for children, seniors, and people with disabilities.
The administrative costs of the program are less than in the private insurance industry and Medicaid costs have increased less than private health costs.
Medicaid is an expensive part of the state budget because health care overall is expensive. It has not been a black hole at all, but quite the opposite. It has been a reasonably efficient way to provide basic health care services to people who need help.
The pundit also calls expanding Medicaid foolish and counterproductive. It is a safe bet that the folks in North Carolina with incomes less than $15,000 a year who would finally have health care coverage would disagree.
A recent report from the Kaiser Commission on Medicaid and the Uninsured found that North Carolina would actually reduce the number of people without insurance by roughly half with the expansion of Medicaid and the other provisions of the Affordable Care Act. That's more than 500,000 people.
The report also finds that hospitals in North Carolina will receive $13 billion over the next ten years to provide care for Medicaid patients if the state expands the program.
The hospitals will care for many of the patients even if Medicaid is not expanded but far more ineffectively and the costs will be passed on to the rest of us anyway.
McCrory hasn't said much lately about the Medicaid expansion. He didn't seem too excited by the idea during the campaign, when he was being careful not to seem supportive of an idea so vigorously opposed by his right-wing base.
But he is not a candidate any more, he's the governor, charged with looking out for the interests of all the people in North Carolina, not just the pundits on the far right or those wealthy enough to afford health care coverage.
Polls show that public support for the Affordable Care Act has grown considerably. Exit polls on Election Day found that more voters wanted the law to be expanded or remain the same than wanted it fully or partially repealed.
The more the American people learn about the Affordable Care Act, the more they think it makes sense. Let's hope that's true for our new governor too. Basic health care coverage for more than 500,000 low-income people he represents hangs in the balance.
By Chris Fitzsimon, NC Policy Watch