One of the options of the Affordable Care Act was the option for states to expand their eligibility requirements to receive Medicaid coverage. This is essentially health insurance coverage for the indigent. The issue has been discussed by the North Carolina General Assembly for years, but it has continued to be rejected.

The expansion would add about 500,000 people to Medicaid coverage and bring in millions of federal dollars to pay for the coverage. North Carolina is one of only 12 states that have not taken advantage of the expanded coverage. Republicans have said that the feds could withdraw funds in the future, and thus the state would be liable to pay for that coverage. That hasn’t happened to date and no longer seems to be a viable excuse. Considering the billions in state surplus funds this year, this has been a more difficult argument for refusing to provide this coverage.

Without this coverage, poor people usually end up in bankruptcy because they can’t pay for their medical expenses. As nonprofits, public hospitals supposedly are required to offer free services to those who cannot pay. In practice, both public and private facilities put their bills out to collection agencies. As a result, a lot of people simply go without any access to medical care. That doesn’t seem to be a moral issue for Republicans. They frame the issue as just another “give-away” and/or entitlement to the lazy who refuse to assume responsibility to pay their debts.

The expansion seemed to be close to passage this summer, but as usual, got deadlocked in squabbles over secondary issues. Pundits are speculating that the expansion still may take place this fall even though the formal budget for the next state fiscal year has been approved. So far public pressure has not been strong enough to force any action on the issue.

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