Editorials

The governor should get louder on Medicaid expansion

In 2016, shortly after Democrat Roy Cooper was elected governor of North Carolina, this editorial board urged him to “be loud” in voicing the moderate and progressive positions that propelled him to office. It was about all the new governor could do in the face of a Republican legislature with a veto-proof majority, but last November, that changed. Voters delivered Cooper a blue wave of friendly faces, giving him more power than any governor, Democrat or Republican, has had this decade.

Now, Cooper is once again navigating an issue critical to North Carolina — whether to accept federal dollars to expand Medicaid in the state. Our advice to the governor: Be louder.

Frustrated progressives would like Cooper to veto any budget that arrives at his desk without Medicaid expansion, but to this point the governor has been reluctant to take that stand. We agree with Cooper. We’re not fans of political ultimatums, nor holding legislative items hostage for the sake of another. It’s also a bad idea to place significant policy items in the budget instead of introducing them in separate bills that would be subject to proper debate.

Republicans say they’re having conversations about Medicaid expansion, but thus far they’ve made little progress in getting a legitimate bill to a vote. That leaves Cooper with the other tool he’s had all along — the bully pulpit. Cooper has been a strong Medicaid expansion advocate, but with House and Senate Republicans working their way toward a budget agreement, now is the time for the governor to more forcefully and frequently make the case. He should do so across the state he governs.

It’s not a difficult case to make. Medicaid expansion would bring critical health coverage and medicine to an estimated 500,000 North Carolinians. It would help struggling rural hospitals keep up with the costs of providing care to the uninsured. It would help stem the state’s opioid crisis. It would save lives.

In making that case loudly, Cooper also might force Republicans to make theirs. NC Republicans should explain the downside of protecting thousands of constituents from difficult choices about medical care and debt. They should explain why they’re not leaping at the opportunity to give hospitals in their rural districts a lifeline, and why they’re ignoring business leaders who think Medicaid expansion is a good economic idea.

Voters also should hear more fully why Republicans are blocking something that 36 states, including some with Republican-controlled legislatures, have adopted. Those that have done so have seen positive impacts on their economies and, most importantly, positive health outcomes for the previously uninsured.

By making Medicaid expansion a more urgent debate, Cooper may nudge Republicans to negotiate a viable Medicaid expansion compromise. Until now, Republican leaders have been able to ignore previous governors, including Republican Pat McCrory. The possibility of a Cooper veto surely changes that calculation.

It’s possible, perhaps even likely, that Republicans continue to dig in against expanding Medicaid. Cooper will then face a tougher call about whether to take more drastic action. For now, the governor should force the issue in a different way. He should make Medicaid expansion the debate of the moment, and he should do it loudly.

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