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Hood: Cooper errs on Medicaid


Tuesday, January 10, 2017

Roy Cooper spent his last few weeks as governor-elect of North Carolina attacking the state legislature for encroaching on the separation of powers, weakening the rule of law, subverting the will of the voters, and hurrying new policies through too quickly, without adequate discussion or consultation. He then spent his initial few days as governor of North Carolina doing precisely what he’d accused the legislature of doing.

Cooper’s first big mistake involves the same issue that severely damaged Barack Obama and his administration: the Affordable Care Act. The president came into office determined to expand government control of health care. He spurned contrary views and pushed through what he wanted. The public didn’t like it. Obamacare is the single-biggest reason why the Democratic Party is at its weakest point since the 1920s.

But progressives remain convinced that policy success and public approval are just around the corner, and that Republicans won’t repeal and replace the ACA’s core policies of Medicaid expansion and government-run insurance exchanges. I don’t know if Cooper agrees with them or believes he has no choice but to indulge the fantasies of his political base. I do know the decision he announced on Jan. 4 — to seek Medicaid expansion in North Carolina through executive action — is a colossal blunder.

Republican lawmakers have passed multiple laws to forbid Medicaid expansion without their approval. They get to do that. Medicaid expansion requires a state appropriation to match federal dollars. It is also a policy matter about which the legislative branch has constitutional authority.

I don’t see any way for the ensuing legal dispute to end well for the governor and Democrats. Either the North Carolina Supreme Court will confirm the obvious and deny Cooper the arbitrary power he claims to have to change state policy and appropriate state funds. Or, having just shifted from a 4-3 Republican majority to a 4-3 Democratic one, it will issue a dishonest opinion that will seem far partisan than anything the GOP-majority court ever did — while still not giving Cooper an actual win on Medicaid expansion.

How come? Because by the time such a decision is rendered, there won’t be an Obama administration to play with. The Trump administration is hardly likely to approve a Democratic governor’s scheme to circumvent the will of a Republican legislature. Moreover, the Republican Congress will likely reform Medicaid in ways that will make the dispute moot, either by forestalling expansion altogether or by rewriting the rules in such a way that state Republicans may decide to accept somewhat-broader eligibility rules in exchange for spending caps, flexibility, and private options.

By claiming unilateral authority to expand Medicaid, Gov. Cooper destroyed the political narrative he and his progressive enablers in the media had created after the 2016 election. Whatever you think of the Republican legislature’s decisions they didn’t constitute a large-scale change in public policy or obligate the state to spend billions of dollars without legislative approval.

The governor’s Medicaid gambit encroaches on the separation of powers, weakens the rule of law, and subverts the will of the voters who have elected a Republican president and Congress to take health care policy in a different direction. It also represents a major policy change hatched without adequate discussion or consultation, thus alienating even longtime advocates of Medicaid expansion such as the state hospital association who want bipartisan action.

John Hood is chairman of the John Locke Foundation.