To be continued: rather than rushing to expand Medicaid, state leaders should wait to see how the Republican-controlled Congress alters the Affordable Care Act.

Author:Hood, John
Position:Free & Clear
 
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Politics is not a feature film with a definitive ending, be it happy or sad. It's more like one of those Flash Gordon serials from the 1930s. Sure, there are breaks in the action from one sitting to the next. But they are cliffhangers, not denouement. Just as your most-admired hero or most-reviled villain overcomes one challenge, another presents itself. The story keeps going. The audience keeps watching.

In North Carolina politics, I think the next big plot twist will involve Medicaid expansion. Gov. Pat McCrory has signaled that he will seek federal waivers for some kind of expansion in 2015, possibly following in the footsteps of fellow GOP Gov. Mike Pence of Indiana. Senate leader Phil Berger and other key legislators seem disinclined to go along, noting that Pence has yet to get what he wants from Washington and other Republican governors have, in the end, settled for relatively minor tweaks in Medicaid-expansion rules in exchange for "free" money.

If your long-term goal is Medicare/Medicaid for all--a single health-care payer under government control--then you're happy with such an outcome. So is the hospital lobby, which actually gets most of the money in question. But for the rest of us, expanding Medicaid has always been the wrong solution to the right problem, which is inadequate access to necessary care by those who lack employer-based health coverage and the generous tax subsidies attached to it.

Though I can understand the intense pressure on state leaders to capitulate on Medicaid expansion, they should resist it. Thom Tillis's victory and the Republican takeover of the U.S. Senate have dramatically changed the situation. The best course for North Carolina is to wait to see what reforms the new Republican Congress may be able to enact in 2015 and 2016. Obviously, President Obama would veto any repeal of the Affordable Care Act itself, but that doesn't mean there aren't ways its features might be modified, with the president's acquiescence, to enable a more market-driven approach to reform.

A year ago, Obamacare was widely predicted to be the signature election issue of 2014. As the campaign unfolded, however, other events --state legislation here in North Carolina, Ebola and the ISIS crisis elsewhere--made headlines. So the conventional wisdom swung too far in the other direction, to the notion that President Obama's primary domestic-policy achievement was no longer a key issue in the midterm elections.

That's nonsense. Public...

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