Wednesday, January 30, 2019

NCGA Democrats Push the Issue of Closing the Medicaid Gap

The "long session" of the North Carolina General Assembly gets underway this morning, and the newly energized Democrats (still in the minority but feeling feisty) came through the door loaded up and truckin'. Senate Bill 3, "An Act to Close the Medicaid Coverage Gap," was introduced by senators Ben Clark, Dan Blue, and Glady Robinson in the Senate. The identical language was filed in the NC House as HB5.

Gary D. Robertson offers this forecast: "...Cooper and legislative allies seem ready to negotiate hard for expansion to cover hundreds of thousands of uninsured people .... Some House Republicans support a bill that would place a work requirement on enrollees, but Senate leader Phil Berger remains unconvinced that expansion is fiscally sound."

Phil Berger is wrong. Every state's experience of expanded coverage under the Affordable Care Act has been economically positive. Improved payments to small and rural hospitals, especially, with upticks in employment and economic development, have brightened the prospects of every state that's gone there (Henry J. Kaiser Family Foundation).

Phil Berger could, and probably will, tank these Democratic initiatives, but he's going to have members of his own caucus squinting in his direction.

Phil Berger
Or ... maybe he's capable of evolving. That hint of "a work requirement" opens the door a crack for even a hardliner like Berger. To the Republican grassroots, a work requirement might signify adequate Republican punishment of shiftlessness while covering an actual Republican surrender to Obamacare. Requiring work of able-bodied adults — who are just a fraction of all Medicaid recipients — in exchange for access to healthcare has become the route for other red-state legislators to cave into Obamacare. That's what happened in Virginia. Kentucky too:
The politics worked: Many Democratic lawmakers went along as assurance that more people could reap benefits from the Affordable Care Act, while Republicans were able to show their base that they were holding people accountable for receiving aid. As a result, Republican-led states have increasingly expanded coverage with such restrictions, and some red states that had already expanded Medicaid are opting to add them. (NC Health News)
The Democratic bills introduced today don't contain a work requirement for able-bodied recipients. Will Democrats fight a work requirement at the risk of losing any Medicaid gap coverage? How will Republicans want to define "able-bodied"? Will Phil Berger remain a killing frost over every attempt to better the lives of his fellow citizens?

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