The decision by North Carolina’s governing Republicans (every single one of them) to reject Medicaid expansion will cost the state’s residents $37 billion by 2022. That is roughly enough money to run the entire state government for 21 months. They looked at the money and just said “no”. They looked at uninsured people living in poverty and just said “no”. They looked at hospitals and doctors who care for uninsured people, and they just said “no”. And they just said “no” to unemployed workers who would have found jobs in the Medicaid expansion.
The Robert Wood Johnson Foundation has published the Medicaid expansion math for every state and it is available on their website www.rwjf.org along with analysis. Here are some excerpts for North Carolina. The ten year cost to North Carolina taxpayers for implementing expansion would have been $3 billion. The lost federal share which the state would have received is $40 billion. That includes $11 billion intended for the state’s hospitals. 40-3=37. Republicans gave away $37 billion of taxpayer money. To add insult to injury, North Carolinians will pay federal taxes to fund the expansion in other states.
After only one year, the effects of the decision are already measurable. There are 414,000 uninsured North Carolinians who could be covered. Hospital chains that operate in multiple states report deteriorating finances in states that rejected Medicaid expansion and improving finances in those that accepted the expansion. Numerous North Carolina hospitals reduced their number of employees in the past year and the rejection of Medicaid expansion is clearly a factor contributing to the loss of jobs.
The effect of the Medicaid decision rippled through the budget just approved by the legislature. Our already inadequate mental health services took another funding cut. If we had expanded Medicaid, most of our uninsured mentally ill adults would have received benefits to help pay for their care. There are far more mentally ill adults living in North Carolina prisons than in our mental hospitals. Nobody knows how many of those taxpayer financed jail terms could be eliminated through improved mental health services financed by Medicaid. Teachers’ aides and media assistants who lost their jobs might have been funded if we had the Medicaid money because the additional jobs and economic growth created by Medicaid expansion would generate tax revenues for other purposes. Lost opportunities of that kind are hard to measure but they are very real.
There is no logical or budgetary reason for refusing the Medicaid expansion. Legislative leaders and the governor did not seriously debate the financial or human costs of their decision. There was a lot at stake: health care for our poorest citizens (including many who work to support themselves); $37 billion of our money; better mental health funding; and jobs for some who are now unemployed. They just said “no”.
A fascinating political observation is that not one Republican legislator voted for expansion or spoke up in favor of it. It seems unreal that with so much at stake there was not one person who had the courage or foresight to buck the Republican party line. Was the control by Thom Tillis, Phil Berger and Pat McCrory so tight that no one dared to challenge them or did every Republican legislator drink the same tainted Kool-Aid?
After this shameful performance, most of the Republicans want to be re-elected. Thom Tillis thinks his performance as Speaker of the NC House qualifies him for promotion to US Senator. As our November 4 election approaches, voters have the opportunity to insist that candidates in both parties say “yes” to the uninsured, the mentally ill, those who care for them, and to those who will find employment as a result of Medicaid expansion. Candidates should also answer “yes” to taxpayers now being forced to pay for Medicaid expansion in other states without getting the benefit at home. As for Thom Tillis, this election is his performance appraisal by voters – an opportunity to just say “no” we won’t promote you to Senator after you gave away $37 billion tax dollars meant for our poorest citizens.