Barack Obama returned to the White House recently – to mark a new executive order expanding access to health care. The former president and the present one clearly enjoyed sharing the stage again. President Biden spoke eloquently, if less colloquially than in his hot mic moment, of the importance of the Affordable Care Act. I was taken with Biden’s description of Obama’s central purpose in enacting this century’s most consequential statute:
“He would remind me every day why we’re doing this – for people who needed it and deserved to be treated with dignity. Dignity. The idea that when you can’t afford health insurance for your children, for your spouse, not only are they in trouble, but you’re deprived of your dignity.”
Obama’s refrain brought to mind a conversation I had a few years ago with an inspiring grandmother from Ahoskie, N.C., Sonya Taylor. She came from a family of sharecroppers. “It was instilled in me at a very young age, if you want to eat, you have to work,” she reported. She’d worked full-time her whole life, as a bookkeeper and retail manager. But a few years earlier she’d endured a six-hour fusion operation for scoliosis. Losing insurance coverage after the surgery, she had to forgo therapy treatments she couldn’t afford..
Ms. Taylor’s family has a worrisome history of cancer. In the past two years, she’d had troubling bowel and intestine symptoms. But she couldn’t pay for the necessary screenings. She and her family fell into North Carolina’s Medicaid coverage gap. Her kids’ father had been diagnosed with cancer a year earlier. He couldn’t get health care until he was terminal. Taylor told me:
“I live in fear. My kids deal with constant worry they’re going to lose their mother. If I woke up tomorrow and got an email saying I qualified for some type of insurance, it’d change my life. It would be a godsend to me and my family. It is so disheartening now, because my kids see I have to fight for every bit of medical care I get. I’ve got grandkids. I want to see them grow up. I feel like I’m fighting for my life and North Carolina could care less.”
North Carolina is one of 12 states that still hasn’t expanded Medicaid. Four million poor people in those states are thus cast out of the health care system of the richest nation on earth, over 600,000 Tar Heels. Folks like Ms. Taylor. Suffering purposeless indignity.
It’s been almost a decade since we passed a statute refusing expansion. We’ve fought much. Over-heated words have been exchanged. Even some from me. But it’s no longer 2013. An array of Republicans, looking pointedly at the consequences for their communities and constituents, seem open to change, whether modest or substantial. Apparently some are in leadership. It’s also clear Obamacare is here to stay. Republicans in Washington don’t move to replace it even when they’re in power. And the sliver of states choosing to unilaterally reject federal health care dollars for their own poor citizens while subsidizing those of the other states grows smaller with each legislative cycle.
The question now is whether we’ll insist on being, what, the final holdout? And if so, why? We’re not going to force the repeal of Obamacare from Raleigh. And we’re not going to balance the federal budget on our own dime. Let’s offer this dignity to all Tar Heels, even if we’re late to the call. Then everyone can go on to fight, on other fronts, on other days. The likes of Sonya Taylor deserve it.
Editor’s Note: Other states that have not expanded Medicaid include Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming.
Gene Nichol is Boyd Tinsley Distinguished Professor of Law at the University of North Carolina School of Law and in 2015 started the North Carolina Poverty Research Fund after the UNC Board of Governors closed the state-funded Poverty Center for publishing articles critical of the governor and General Assembly.