One hit, one miss from Cooper on Medicaid

The Observer editorial board

North Carolina will have missed out on about $25 billion in federal money by 2020.
North Carolina will have missed out on about $25 billion in federal money by 2020. THE CHARLOTTE OBSERVER

Gov. Roy Cooper’s push during his first week in office to expand Medicaid raises at least two pressing questions: Should North Carolina expand Medicaid? And: Is Cooper going about it the right way?

The answers: Yes and no.

Democrats were quick to applaud Cooper last week when he vowed to get North Carolina included in the Medicaid expansion made possible by the Affordable Care Act. The only catch? His effort is almost certainly illegal.

We get that Democrats are giddy that Cooper, not Pat McCrory, is now North Carolina’s governor. Understandably so. But that doesn’t mean they should reflexively applaud anything he proposes. Legislative Republicans believe the ends justify the means. They are no model for how to conduct business, though, and Cooper should get both the ends and the means right.

Republicans passed a law in 2013 that says in part “The State will not expand the State’s Medicaid eligibility under the Medicaid expansion provided in the Affordable Care Act… No department, agency or institution of this State shall attempt to expand the Medicaid eligibility standards provided in (state law) … unless directed to do so by the General Assembly.”

That’s unwise, but also abundantly clear.

Cooper’s rebuttal is dubious. He argues the 2013 law is void because it impinges on his constitutional duty to look out for North Carolinians’ health. By that argument, the governor’s powers would be unlimited, with him justifying all his actions as being for the good of the people. In any case, the provision has not been challenged in court and so is unquestionably the current law of the land.

All that said, Cooper’s stance is valuable because it puts the spotlight back on Republicans’ utter failure to care for some of this state’s most vulnerable citizens. They will have rejected some $25 billion in federal health care money through 2020, imperiling real people’s health, solely in service to their mean-spirited opposition to all things Obama. Thirty-one states have accepted the money, including many led by Republican governors such as Mike Pence, John Kasich and Chris Christie.

Republicans can chide Cooper for ignoring the law, as Senate leader Phil Berger and House Speaker Tim Moore did last week. But Cooper’s action demands that Republicans explain how they will deal with the 500,000 or more North Carolinians who are too poor to afford health insurance. Those people get no health care or get it in the most expensive way possible: In the emergency room, and after their health has deteriorated. Who picks up the enormous tab for that? The hospitals and you.

North Carolina’s acceptance of Medicaid expansion would pump $2 billion to $4 billion in federal money into the state. It would improve residents’ health and boost the economy, particularly in rural areas.

North Carolina would pay a nickel for every 95 cents the federal government pays. Cooper suggests the hospitals pay that nickel. They would probably gladly do so, given the level of indigent care they provide already, but are afraid of angering Republican legislators.

Cooper’s maneuver won’t fly. But he has the right goal, and North Carolinians should get behind it.