Just saw this a minute ago as I was getting off a call
#ncpol presser that #nchouse and #ncsen have reached an agreement on #medicaidexpansion
1/— NC Health News (@NCHealthNews) March 2, 2023
North Carolina is a divided government state. The Legislature is heavily Republican and the Governor is a Democrat. The Legislature had tried to work out an Expansion deal last year as part of a “dessert and vegetable” deal where all sorts of health policy changes were wrapped up into a single bill so every interest group got something it wanted even if lower priority things that they did not want also were included. The House and the Senate could not agree and the deal failed. However the framework that Medicaid Expansion was something that all key veto players in the state wanted had been established, so haggling on how to get there instead of haggling over whether or not it was something to be desired had continued.
More details as they emerge.
Fake Irishman
Emma Sandoe’s Twitter feed is going to be 🔥.
(maybe she’ll make a cake?)
David Anderson
@Fake Irishman: She makes very good cakes!
RevRick
This is a BFD!
Fake Irishman
Also, there’s something to be said about the slow and steady expansion of states, like the original Medicaid program (took 17 years for all the states to sign up), good policy does tend to spread, even in the teeth of ideological opposition. I’d have to check, but at the end of the day, that even some Republican legislative bodies have approved this is interesting
David Anderson
@Fake Irishman: Now, I have to admit, I have a problem. I see discontinuities everywhere around me.
The current deal is for the expansion program to start on January 12, 2024. This is WEIRD! As someone who earns 133% FPL and applies for January 1 coverage on Healthcare.gov in December 2023, they will only be eligible for ACA CSR coverage. However that same person enrolling on January 13th at the end of the OEP will be sent to Medicaid.
My understanding is that people who are ACA eligible at the moment of determination are very likely to keep their plan for the year. There is going to be a very large wedge of folks who will be on higher cost-sharing plans just due to an artificact of timing —
From a policy researcher perspective, this is one hell of an plausible exogenous discontinuity to exploit, from a policy perspective this is likely dumb!
Fake Irishman
Now what about Kansas? And for the love of God, can some one get this on the ballot in Florida for 2024?
Fake Irishman
@David Anderson:
That’s the lot of researchers, right? dumb public policy is often good research design. In making the Medicaid expansion optional, the Supreme Court probably killed thousands of people, but it made my faculty career possible in its present form.
David Anderson
@Fake Irishman: Yep!
Fake Irishman
@RevRick:
I think we found Joe Biden’s BJ burner account….
Baud
Amazing work by all involved.
NC could be one the best states in the union of it were blue IMHO.
AM in NC
About damn time. Phil Berger and Tim Moore can (and rightfully should) rot in hell for the vandalism they have perpetrated on our state.
Mike E
Maybe the TEA legislature will allow this expansion if Roy agrees to not veto some other closely contended bill (I don’t think he can successfully veto the “ditch gun permits” bill should it advance to his desk). The governor has done about as well as any reasonable executive could under the current political alignment (which is a veto override if just one Dem in the house switches, the bookend to Cooper’s start of his term when they overrode his vetoes seemingly at will).
Fake Irishman
I think this is also one of the first two states to take advantage of the huge windfall available under the American Rescue Act, right? That’s got to be worth and couple hundred million extra bucks in the budget for a few years.
Jerry
Last I heard, the Repubs wanted to add a work requirement to our expansion, which makes no sense. But I wonder if that will be in the bill.
Fake Irishman
@Mike E:
I don’t think the legislature is going to be demanding blood in this case. This press conference are the GOP leaders saying they have a deal. That almost means they’ve got enough votes to pass this and buy in to get it to the floor. Indeed, both chambers passed something last year.
CaseyL
Sigh. North Carolina is one of those states that I always think would be really lovely if it weren’t run by the GOP. Best wishes for getting the Medicaid Expansion across the finish line and onto the Governor’s desk!
Ohio Mom
@Fake Irishman: I had no idea Medicaid took 17 years to become adopted by every state. I had assumed it was nationwide as soon as LBJ signed the legislation (well, not instantaneous, I realize it needed to be ramped up).
It is a lifeline for my disabled 25 yo son. I can’t imagine our lives without Medicaid.
Kevin the Hen
Fuckers killed the SAVE act in the process though. Would have allowed NPs and (maybe PAs) to practice independently rather than
as indentured servantshaving to have an MD “supervise” them. Berger was pushing for it because there will be a need for more providers when expansion happens.Betsy
This is fabulous news, and there were strong suggestions that it was on the way.
Why do you think the crazy Republicans ultimately dropped their opposition?
Was it the closing of so many rural hospitals? — did healthcare execs put pressure on the Republicans
moronic fasciststo at least become practical neoliberals on this one issue?Betsy
@AM in NC: They are genuinely, throughly rotten pig people.
No offense to real pigs.
Baud
@Ohio Mom:
Me either. We have a bad habit of assuming all past accomplishments were easy.
Mike in NC
Things were going well in NC until the racist Tea Party movement kicked off in 2010 and Republicans pulled out all the stops to mobilize their voters and demonize Obama.
The NC General Assembly seems likely to endorse medical marijuana this session, though weed will probably be legal nationwide in 4 or 5 years.
Betsy
@Baud: It was one of the best states and has been almost destroyed, made practically unrecognizable, by republicans.
A lot of them were cretinous right-wing northerners who moved here because they thought they could be safely racist in the south.
Among other things, racist transplants nearly destroyed the best-performing large school system in the country (Wake County Public Schools) by trying to re-segregate it, nearly succeeding until ferocious local defenders of the very successful diversity policy threw/voted them out on their sorry racist nazi New Jersey asses. But they continue to spearhead legislation that would have been considered unthinkably regressive just a generation ago.
Betsy
@Mike in NC: Dick Armey’s operation Americans for Prosperity and the Koch Bros have really targeted the state with their astro-turfing tactics and that whole legislative playbook they are running in multiple “purple state” legislatures — Ohio, Wisconsin, Pennsylvania have been targets along with NC of these tactics.
delphinium
@Kevin the Hen: NY just recently (2022) passed a law giving NPs full practice authority, including the ability to prescribe medications for patients without having to sign a contract agreement with a supervising physician. Many other states have similar laws. I have hope NC will vote again on something similar once the medicaid expansion goes thru and provider shortages become even more apparent.
delphinium
@Betsy: So sorry to hear about all this. Those Republican-funding assholes can’t fuck off fast enough and take their money with them.
RevRick
@Fake Irishman: I’m not saying that’s malarkey….
Fake Irishman
@Ohio Mom:
Alaska didn’t adopt it until 1972 and Arizona held out until 1983. In Arizona, a conservative legislature stopped the program by refusing to fund it even after voters approved it in a referendum. Eventually they got it done with a massive Section 1115 waiver plan (that still exists today; it’s the first massive experiment with managed care)
Sound familiar?