The ongoing debate about the economic impact of HB2, North Carolina’s “bathroom law” seems both sad and laughable because its effect is so small when compared to another foolish decision made by the state’s Republican legislature. The economic and human damage done by the decision to reject expansion of the Medicaid program is greater by far.
Republican friends, before you disagree, do your homework and discover the facts for yourselves. Bring truth to the debate and then see how your legislature’s decisions look under that bright light. Before considering human impact, let’s examine some raw financial facts.
The Robert Wood Johnson Foundation and the Urban Institute have collaborated on research to understand the economic impact on states that rejected Medicaid Expansion. They found that health care funding in North Carolina would be increased by $41 billion in the decade from 2017-2026 if the state accepts Medicaid expansion. That would require $4.9 billion of state funding and would bring $36.1 billion in federal funding. Do the math. $36.1 minus $4.9 equals $31.2 in net gain. Another way to look at it, suppose someone offered you $36.10 in exchange for $4.90. Would you accept it? That is one billionth of the deal that Republicans rejected. The legislature knew this information when it rejected the Medicaid expansion.
Some will argue that our state budget is too large and we shouldn’t increase it further by expanding Medicaid. That is a reasonable concern, so let’s look at Medicaid expansion in the context of other government spending.
Most federal highway grants require a 20 percent state match. State funding of $4.9 billion would produce a federal highway match of $19.6 billion. That is $16.5 billion less than we would get if we spent the money on Medicaid expansion. Therefore, if one accepts purely financial justification for not expanding Medicaid, the state would be better off by $16.5 billion to reject the highway match and use the money to fund Medicaid.
In addition to providing health care to uninsured North Carolinians, the Medicaid expansion would create thousands of new jobs in health care to replace those lost in other industries.
The argument that “we can’t afford it” doesn’t hold water when made by legislators who spend money on items that yield a far smaller return on investment. It’s a matter of priorities, and this legislature obviously sees other spending as more important than keeping poor people alive and creating jobs.
What about the human effect of the decision? The Medicaid expansion was designed to provide coverage for the working poor, many of whom have jobs (sometimes more than one job) but who are paid so little that they can’t afford insurance even with the help of the Affordable Care Act. Whatever became of that right wing mantra “take a bath and get a job”? As cynical as it sounds, the Medicaid expansion is designed to support exactly that behavior. It provides health care for people at the bottom of the economic ladder so that they can stay healthy enough to work and support themselves.
Instead of supporting a program that fits with their own traditional philosophies, Republicans rejected the expansion. That leaves us with a law that requires hospitals participating in Medicare and doctors with privileges to practice there to provide emergency and obstetrical care without regard to a patient’s ability or willingness to pay. The cost of that is invisibly built into the prices paid by everyone else. As a result, North Carolinians will pay for surgery to add a few months of life for an emergency patient diagnosed with advanced colon cancer. But we won’t expand Medicaid to pay for the colonoscopy that could have prevented the cancer from forming in the first place. The result of Republican policy is higher cost and a dead patient.
Yes, HB2 is a foolish law that should be repealed. Yes, the cancellation of concerts and sports events has an economic impact on hotels, restaurants and tourism. Yes, the law unfairly discriminates against a largely defenseless class of citizens. Yes, it should be repealed. But so far no one has died as a result of HB2 and the economic impact is microscopic compared to the rejection of Medicaid expansion.
It’s a fabulous opportunity when the right thing to do is also the profitable thing to do. We have two such opportunities at the moment. Accept the Medicaid expansion. Repeal HB2. Everybody will win.
Republican friends, the facts don’t support your policies. It’s time to change your minds.