Raleigh, N.C. — With the Affordable Care Act headed for the U.S. Supreme Court this week, the NAACP and Democratic state lawmakers are renewing calls for North Carolina to accept the law's Medicaid expansion.
The case before the court, King v. Burwell, challenges the legality of federal subsidies for health insurance in the 34 states, including North Carolina, that did not set up their own state exchanges, choosing instead to use the federal HealthCare.gov marketplace. Foes of the law say four words in it should allow subsidies only in states with their own exchanges.
If the Supreme Court agrees, it could mean the end of coverage subsidies for around half a million North Carolinians, warned Rep. Rosa Gill, D-Wake, at a news conference Monday morning.
"It could be devastating to the Carolinas," Gill said. "Insurance companies, medical professionals and others may lose their financial stability."
Yet, Gill and state NAACP President Rev. William Barber say the state should accept the federal Medicaid expansion provided under another section of the ACA.
Gov. Pat McCrory and Health and Human Services Secretary Aldona Wos said last month they won't advance any expansion proposal until the Supreme Court makes a decision in the King case because its outcome could have "many ramifications" on the ACA.
Barber accused McCrory and Republican legislative leaders of "stonewalling," noting that they've implemented laws they favored, such as voter photo ID and school vouchers, despite ongoing litigation.
"People can bring cases over and over and over again," Barber said. "But the Medicaid program in the Affordable Care Act has already been proven to be constitutional, and we should be acting in accordance with that."
Under the ACA's original design, states would have been required to expand Medicaid to cover low-income working adults making up to 138 percent of the federal poverty level – about $27,000 for a family of three. Those making more are eligible for federal subsidies to help pay for health insurance.
But the Supreme Court ruled in 2012 that states could not be forced to expand their Medicaid programs, even though the federal government would cover virtually all the cost.
In North Carolina and other states that declined to accept Medicaid expansion, people making between 100 and 138 percent of poverty level fall into what's known as the "Medicaid gap" – they don't qualify for subsidies because they were intended to be on Medicaid instead.
Republican legislative leaders have repeatedly said they won't expand Medicaid under the ACA. Senate President Pro Tem Phil Berger said in January, "There is no good case to be made" for expansion."
"That's flawed logic," Barber said. "They didn't allow North Carolinians to make the case."
Barber says the expansion would cover hundreds of thousands of working poor who can't afford coverage, would help struggling rural hospitals and would boost economic activity and job creation.
While many states with Republican leaders have chosen to accept Medicaid expansion, Barber pointed out that almost none have been in the South, where some 60 percent of black Americans live. He called it "the new political civil war."
"He [McCrory] Berger and Stam and them are standing in the doorway of hospitals. You can imagine how those old governors stood in the doorway of universities and schools. They’re standing in the doorway of hospitals and access to health care for people who need it," Barber said.
The NAACP and political allies are holding what they're calling a "people's grand jury" to hear testimony from doctors, gravely ill patients without access to health care and community leaders who favor expansion. The group's attorneys are listening for legal bases to "bring charges" against state leaders, from violations of the equal protection clause to potential wrongful death claims.
"There is no good reason to be denying Medicaid expansion," Barber told reporters, "and there is every good reason – morally, personally, from the health perspective and the economic perspective – to in fact expand Medicaid in North Carolina."