North Carolina Lurches Toward the 21st Century
By 
Against the will of the state’s Republicans of course.
Just after the Affordable Care Act fully took effect in 2014, around two dozen GOP-run states were refusing to implement the ACA’s expansion of Medicaid. This left millions of Americans languishing in a needless crisis, all because ACA-despising Republican legislators were turning away enormous sums of federal cash earmarked to cover their state’s poorest adult residents.
But in the near-decade since, health-care advocates have painstakingly overcome that opposition, and many of those states have now embraced the expansion. Between this and the failure of years of ACA repeal drives, the GOP has essentially been routed in the Obamacare wars.
The scale of this defeat is evident in big news out of North Carolina, where leaders in the GOP-controlled legislature announced a deal Thursday to accept the expansion. It will require hospitals to pay the state’s minimal contribution to the cost. (The federal government generally funds 90 percent.)
Republicans accepted this deal only after years of ferocious resistance. And this is a tremendous win for advocates and Democrats, because it stands to cover as many as 600,000 poor North Carolinians, in a state that proponents have targeted for years.
The popularity of Medicaid appears to have surprised conservatives, who apparently saw it as an easily targeted big-government program for poor people. The prospect of cuts to Medicare — whose beneficiaries are vocal, organized seniors — presented a well-understood danger. But surely Medicaid cuts wouldn’tmatter as muchpolitically.
Reality has shown otherwise. In the past dozen years or so, voters in seven GOP-run or red-leaning holdout states have defied Republican legislatures by voting in referendums to accept the expansion. In a number of others, Republican officials have initiated acceptance through executive actions or legislation. If North Carolina’s legislature passes the new deal, only 10 holdout states will remain.
The Party of Death is outraged. Also, everyone under the age of 40 hates them.