The deal in the wide open

Five months into the North Carolina Republican Party’s total control of State Government for the first time since the 19th Century (Governor’s mansion, State House and Senate), several things are clear.

  • First, Republicans have had gotten a lot of what they wanted quickly: voter ID, a soon-to-be repealed racial justice act, and a substantial reduction in unemployment benefit costs that will greatly reduce benefits on July 1.
  • Second, getting what they want the most–a tax code reformed to their liking–will be more difficult for a variety of reasons including differences within their party regarding what is ideal, the fact that they now own the budget process and have to make the ‘trains run on time’, and the simple fact that while tax reform is easy in sound bites (lower the rate, broaden the base), it is in reality, very difficult. The bottom line is that it will be difficult for the Republicans to transition to a tax code that is as heavily based on consumption taxes, and away from income taxes (personal and corporate), as they would like.
  • Third, the Democratic Party is still struggling to find its footing in opposition, and the reality is that the most focused counter to Republican rule has not come from the General Assembly, but from the Moral Monday protests. Where this energy goes and to what effect is not not yet clear. However, the elected Democrats seem irrelevant.

There is one unlikely issue where the elected Republicans and Democrats could find a way forward that benefits them both and the people of this State: the Medicaid expansion offered via the Affordable Care Act.

For Republicans who want a more regressive tax structure that they say will lead to economic growth and job creation, the negative effects on the poor of such a change could be balanced by spending-side progressivity that would come from moving 500,000 people from the ranks of the uninsured to the insured. Governor McCrory, whose own Medicaid reform plan may already be too far gone with the State’s medical community, desperately needs a face saving way out on this one. The elected Democrats should stand ready to give it to him via a Medicaid expansion and a commitment to move ahead together to reform the Medicaid program.

It is among the worst kept secrets in North Carolina that our State will eventually expand Medicaid, in part because it is the most obvious way forward that doesn’t forestall future reforms, it provides advantageous economic terms for the state, and the hospitals and health systems that are being asked to pay more in tax reform need a practical means of addressing the uninsured problem. And the map of the States that are not undertaking the Medicaid expansion are not the sort of company that a fairly large proportion of (even) Republican voters in this State want to keep. For progressive and liberal North Carolinians, reducing the ranks of the uninsured by half a Million people would be one of the greatest victories of the past 50 years, and would allow a reset of the ongoing Medicaid reform discussion that the Governor desperately needs, and that could invite the Democratic Party and their natural constituencies into the conversation. The Democratic Party has little to lose as it is not going to win on tax reform in any event, and everyone knows the tax code needs to be updated and modernized. The Republican Party has almost certainly seen the peak of their numerical ascendancy, and it is hard to get things done even with veto-proof majorities (or maybe because of them).

The deal is in the wide open. S/he who has ears to hear, let her/him hear.

About Don Taylor
Professor of Public Policy at Duke University (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute). I am one of the founding faculty of the Margolis Center for Health Policy, and currently serve as Chair of Duke's University Priorities Committee (UPC). My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

2 Responses to The deal in the wide open

  1. Pingback: North Carolina Tax Reform | freeforall

  2. Pingback: North Carolina tax bill | freeforall

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