Expanding Medicaid in North Carolina has been a sticking point for the state’s Republican budget writers and the Democratic governer. The lawmakers declined to include it in the budget and Gov. Roy Cooper said he would veto the budget without it.

This week, Tideland News includes two commentarie, one on the economic benefits of expanding Medicaid and a Republican rebuttal to certain claims about Medicaid expansion.

If you'd like to read the commentaries, purchase a copy of the July 3, 2019, Tideland News.

(9) comments

David Collins

Actually did purchase a copy of the mullet wrapper this morning. Read both sides of this issue and came away quite underwhelmed with the argument for expansion. The proponents seem to only care about scooping up as many taxpayer dollars as possible to create more government funded jobs. These jobs would create a trickledown benefit to the state economy, which is absolutely true. At least as long as the money lasts. Sadly, the folks forced to join the Medicaid program would only add to the already largely underserved population. Medicaid patients will have to rely on special clinics , many with only nurse practitioners on staff and funded hospitals that are required to treat everyone. More and more physicians no longer treat Medicaid patients. Largely because they can not afford to and these patients have a some what dismal record of showing up for scheduled appointments as well. These proponents must have some other motive to really want to create basically a Veterans Administration solution for the lame, lazy or just stupid as well as the illegals that are becoming more visible of late.


The problem is that without the expansion, folks who don't earn enough to be eligible for a Obamacare policy, are left with nothing. Thus, must be seen in emergency rooms at great cost. But, illegal aliens get care. Taxpayers not so much. North Carolina needs this expansion, secondary to large numbers of folks with nothing. This should have been done long ago. The nurse practitioner thing is a bomb waiting to blow. These pseudo-doctors are a boon for physicians, but not so much for patients. The misdiagnoses, mistreatments, poor diagnostic acumen, have left its own trail. The malpractice insurance industry will deal with this at some point, but those harmed along the way will be permanent. Physicians should have to treat these patients, much in the manner hospitals are required to treat at certain levels. Otherwise, we allow suffering. Aren't we proud.


This is so true! I work 2 FT jobs, but neither offers insurance. I can get Obamacare but without expanded Medicaid, my younger daughter would't qualify. It's frustrating for me, as I have to work a lot in order to survive, but never qualify for any services. There are a lot of us in that prediction. None of us want to have to use Medicaid, but it's our only option. The lowest income families can get help, i.e, food stamps and Medicaid, but those of us in the middle will lose out if they don't expand the program. Frustrating for all of us in the middle and who are striving to raise our standards of living as well as our kids. In terms of Medicaid options for care, my oldest daughter needed braces b/c of a medical condition. There is no one in the county accepting Medicaid for braces and the closest one who does is in Jacksonville with a one year wait list. Since this is a medical condition, I will have to self pay, which adds even more financial stress. I think that there should be some sort of middle ground where those of us who are working our bottoms off can at least get medical insurance for our children, which expanded Medicaid has done for my family. Without it, my daughter would have no care for her medical issue and I'd just have to find a way to pay for it out of my pocket. It is frustrating to me to see many people play the system and seem "poor" while collecting lots of services and have a higher standard of living than me. I don't know the answer, but I do know that expanded Medicaid is a benefit to someone like me who can't get any other assistance.

David Collins

These clinics are largely part of a hospital network. The in house practitioner evaluates, treats to their allowed range and then refers to a primary care physician, if necessary. This process can take some time because there are fewer and fewer primary care, used to be called general practitioners, folks in the business these days. The primary care physician, in addition to being at the bottom of the medical economic food chain, are quite overloaded. That is why we have assembly line medicine with 12 to 15 minute appointments. That is also why so many primary care folks are leaving. Am currently on my third primary at this moment. Once you have cleared the primary hurdle, a referral to a specialist might be in order. Have had to cool my heels for as long as 90 days before being seen and then having to wait for an additional length of time for any procedures. This is happening all over, not just here. The professional liability attorneys have a role in this problem but that is for another time. The medical folks always have some legal beagle sniffing about so they do proceed with caution. Allowing more government intrusion, comes with the money and always does, is not the answer. What has government done well?? Look at the mess at the VA. How soon we forget. What is the answer? Darned if I know. Way too many people and not enough resources, for one. Things are not exactly rosy in the often touted countries, the U.K. , Canada, Norway, Sweden and so forth. The ones that can pay are treated differently because they can pay. Not really difficult to look this up. Just takes initiative. It Takes Money to Buy Your Freedom has never been more true. Sooooo, if expansion happens please do not expect much to change. You will have too much money chasing too little resource and the ones that are profiting now will only profit more. Just the way things workout .


Once again...spoken like true conservatives...nothing should ever be done for the first time. I don’t hear of any of the 30+ states that have expanded Medicaid wanting to get out. It has been a net benefit on many levels. To deny good medical coverage to hundreds of thousands in NC is appalling. It costs all of us. We are the only wealthy country in the world without a form of universal health coverage. Some countries are single payer, some are rule driven private insurance or a blend of the two. By all metrics they spend less for better results. A federal appeals court today may strip coverage from 21 million citizens and Trump conservatives will cheer the death of the ACA. Do they have a plan? No. Despite having had years to form one. Their philosophy is that health care is a commodity like a gallon of milk. If you can’t afford health care, if it bankrupts your family that’s just too bad. The Republican policy is that if you can’t afford treatment then die. There is a special election today for Mr. Jones congressional seat. Two MD’s trying to out-Conservative each other. One saying that it’s too liberal to say any of the ACA is good...like keeping your kids on your insurance until they are 26 or not being screwed for having a preexisting condition. Heads you lose tails you lose. It’s nauseating. Do these people have no conscience? What is lacking is the political will to reform the insurance industry and the drug cartels that run the medical system now. I spent my career as a health professional, some of the comments mentioned above are simply wrong...there aren’t special clinics for Medicaid patients, I know many nurse practitioners that are superior to many MD’s just to mention a few. The jobs created, the health of the community and the better utilization of the health care system cannot be downplayed. The benefits far outweigh the cost, other states and countries have shown that clearly. Why can’t we?

David Collins

Has little or nothing to do with conscience. Once you expand a unfunded give away it is almost politically impossible to take it back. You really think things are so wonderful in countries that have done this? Read this study [ Financing of Healthcare in the Nordic Countries ] . All this wonderful healthcare, or is it really so wonderful, comes with sky high taxes as well. Read all of it but I bet you won’t. The ones that constantly yammer on and on never do. Just blindly follow the pie in the sky progressives that will promise you anything for a vote while hiding the not so great details. That is assuming they even know a little of what they speak. Remember, the politicians have their own private gold plated healthcare plan that only they can get. Soooooo, vote for me and I will set you free lives on.

David Collins

Oh, by the way. Never said a thing about special clinics for Medicaid patients. Just clinics associated with hospitals. The closest thing to a special clinic, that I know of is the free clinic in MHC, I believe. The ACA was a good sounding plan that was designed to fail..was it not Mr Gruber. Every one remembers Mr Gruber, the plan man and all that, then came the paid navigators to firmly ensnare the victims solidly aboard the plan, the real fun was when the plan ran into actual physicians. Physicians that actually expected to be paid for the services provided. Often the results were a bit underwhelming for both sides. Existing conditions is an rip off. Just like wrecking your car, then signing up for insurance an expecting the wrecked car to be fixed for free. Used to be called fraud. now it is some sort of a new deal, new green deal is it? Really hope sagacity takes the time to read that report and spreads the word about, going to be some really sad faces if care like that comes to these parts. Be careful of what you wish for.

David Collins

To those that really think that a national, single payer, health service scheme would be the end all for our problems, have some bad news for you. The British National Health Service, which is free, is also being rationed. Why is this happening? Easy, way too many folks overloading the system. Britain, just like so many other countries does have an immigration problem. This should be a familiar lament to those that have not been living under a rock for the last few years. In order to get the services you want the bill must be paid and plenty of new comers have large extended families and contribute precious little to the system. Again, sound familiar? Not enough first line Drs. available to the initial screening so the folks are being put on a triage list. Yup, some govt. person will decide who gets seen and who waits. Source, page 54, June 29th edition of The Economist. Plenty more for those that chose to be informed.


Another interesting aspect of government waste is the access to free medical care for non citizens. When I lived in Canada as a non citizen, I had to pay out of pocket for my medical care, as it should be. However, the US provides the free medical care (at a cost to the citizens) to non citizens in a myriad of ways, from free clinics and so on. In Canada, the same isn't true. How much money would we save as a country if we didn't pay for non citizens' medical, but focused on our own?

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