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Our view: Life-or-death dithering on Medicaid expansion

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As politicians have dithered, deflected and delayed on the question of Medicaid expansion, some North Carolinians have died for lack of health care.

Too often individuals who can’t afford it avoid doctor’s visits until it’s too late and their illnesses have become too severe to be treated.

There is a cure for that problem in Medicaid expansion.

A component of the Affordable Care Act, the program would provide health insurance for as many as 600,000 uninsured North Carolinians. The federal government would pay 90% of the cost.

More recently, an analysis by the state Department of Health and Human Services projects that the state would receive more than $500 million a month, WRAL reported Tuesday.

The one-page analysis notes: “Not expanding Medicaid to 133% of the Federal Poverty Level (FPL) would cost NC $521 million per month that would otherwise be brought to the state and an additional $15 million in avoided expenditure for every month beginning September 2022.”

In other words, Washington has made us an offer we can’t refuse. And yet we have.

The roadblock to expansion in the past has been a lack of support from Republicans in the General Assembly, who seemed to oppose it mainly on political grounds.

But not only has that resistance begun to fade, some Republicans have endorsed it, most notably the most powerful man in the legislature, state Senate leader Phil Berger.

With Berger’s backing, hopes had been high for a breakthrough this summer.

Then nothing.

The newest state budget was passed by lawmakers and signed into law by Gov. Roy Cooper without any provision for Medicaid expansion.

Yet, even though the legislative session has ended, negotiations continued (one step forward).

Then they hit yet another snag this week (one step back).

Republicans want regulatory changes that would increase competition for the state’s hospitals, WRAL reports.

Specifically, Berger and Senate Republicans want what are called “certificate-of-need rules” to be reformed. Hospital executives have balked at that idea. If these rules were loosened, they say, specialized standalone competitors, such as surgical centers could lure away their most profitable services.

They say hospitals would remain saddled with emergency room expenses with less revenue to pay for them.

The pros and cons of such deregulation are worth a fair and informed discussion. The issue has been debated, off and on, for years. But it’s disconcerting that the Senate would burden the Medicaid bill with it.

A state House version of the legislation contains no such provision.

House Speaker Tim Moore, a Republican, told the Associated Press on Wednesday that he sees no need to rush.

But there should be a greater sense of urgency.

Further,this bill should be clean, without larded-on additives, especially contentious ones.

Now this latest impasse means a longer wait for expansion.

And for far too many North Carolinians, it means a longer wait for critical medical care.

Their dilemma brings to mind the front-line frustrations of a doctor in Berger’s home county, Rockingham, who witnessed the human costs firsthand, over and over, in his Reidsville clinic.

Dr. Steve Luking described North Carolina’s stubborn refusal to expand Medicaid as a failed experiment whose results “have exploded in my medical journals in recent years, like mushrooms after a spring rain.”

Luking added in an April op-ed in the Greensboro News & Record: “Numerous studies have confirmed how the absence of insurance increases the risk of dying from cancer, stroke and heart disease; the risk of renal failure and costly dialysis; the risk of blindness and amputations in diabetics; the risk of disabling mental health disease; and on and on. Mortality studies have revealed that Medicaid has saved tens of thousands of lives in the expansion states. The journals provide the statistics, but I’ve already seen their faces.”

The fact is, North Carolina is one of only 12 states that have yet to expand Medicaid. The majority of North Carolinians favor expansion, including Republicans. It will save lives and money.

For God’s sake, get on with it.

To politicians this may not be a matter of life or death.

But, for far too many of our friends, neighbors and co-workers, this is precisely what it is.


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