Republican Disconnect: Abortion and Medicaid in North Carolina

There is a disconnect between the North Carolina Republican parties’ passionate commitment to protecting the health of women who would choose to have an abortion, and their cool, immediate opposition to the Medicaid expansion available under that ACA. Proponents of S353 spoke in terms of no stone being left unturned to improve and reform abortion clinics on the floor of the House of Representatives during the debate on Thursday, July 11, but they blithely turned their backs on 500,000 of our most vulnerable fellow citizens early this year when they rejected Medicaid expansion.

As the Republican Conference Leader, Rep. Ruth Samuelson (R-Mecklenburg) said in response to questions about the cost of the proposed regulation of abortion clinics (as recorded in Rose Hoban’s live blog of the debate):

“The point that has caused me the most befuddlement, the issue of this being cost-prohibitive, you don’t raise safety because its cost prohibitive. Do we want someone to die in an abortion clinic in North Carolina before raising the standards?” Samuelson said. [she was saying you can’t put a cost on safety/someone’s life]

Rep. Pat McElrath (R-Emerald Isle) offered a similar sentiment that poor women should not be denied access to care because they could not afford to pay for it:

“I’ve listened about safe and healthy access, and that’s exactly what this bill is about,” McElrath said. “Poor women should not have any less access to clean conditions to sanitary conditions than those who can afford to go to that one facility[that now meets the proposed regulations-my insertion] in Asheville.”

I am going to grant the benefit of the doubt to House Republicans that their singular goal is to protect the health of women to drive home the the disconnect between their advocacy of S353–where cost was not even viewed as a legitimate line of inquiry by House Republicans; who could put a price on health and safety!–and their rejection of the Medicaid expansion that could have provided insurance to 500,000 poor North Carolinians, protecting them from financial hardship, helping to ensure access to care, and improving their health.

Cost has often been stated as a reason to not expand Medicaid, even though the terms of the expansion are financially advantageous to North Carolina, and our State could later cancel the expansion for any reason.

Others have said that being uninsured is better than being covered by Medicaid, a politically motivated sentiment that does not hold up to a broad and careful look at the research evidence. All that can be said about Medicaid (and insurance generally) and health cannot fit onto a bumper sticker, but expanding Medicaid would extend access to our State’s health care system in a manner that is supported by our hospitals, and which does not forestall future health care reforms. (Lots on the impact of insurance and Medicaid on health here, with more on the recent Oregon Medicaid study here).

I actually don’t know if there is a particular quality of care problem in abortion clinics in North Carolina, but I do know that there is a general quality of care problem in our nation, with medical errors having been identified as the 7th or 8th leading cause of death in the United States, leading to between 48,000-98,000 deaths in the U.S. in 1999 alone; a decade later, progress had been made, including more focus on quality in outpatient settings, but quality/safety problems remain persistent, including this study showing medical errors remaining a problem in North Carolina hospitals a decade after the Institute of Medicine’s To Err is Human was published. So, I don’t take quality concerns lightly, and efforts to improve quality and improve safety are important.

However, zeal to address these issues shouldn’t be reserved only for women who choose to receive an abortion.

I believe the passion stated by proponents of S353 is real and heartfelt. I also think many of the supporters of S353 think abortion should be outlawed, but I give them credit for stating publicly that access to abortion is a constitutionally guaranteed right. And there may be a particular quality issue with abortion clinics in North Carolina, or there might not be–I truly don’t know.

I would like to respectfully ask the Republican majority that now rules our State to reconsider their decision to not expand Medicaid, and to apply some of the passion and the ‘no cost is too high sentiment’ displayed during the S353 debate toward expanding access to health care to poor people who aren’t seeking an abortion, and then set about developing a North Carolina specific plan for health reform that focuses on access, cost, quality and safety problems wherever they exist. There are many North Carolinians of different political persuasions ready to join them on that journey.

About Don Taylor
Professor of Public Policy (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute), and Chair of the Academic Council at Duke University . I am one of the founding faculty of the Margolis Center for Health Policy. 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

One Response to Republican Disconnect: Abortion and Medicaid in North Carolina

  1. Pingback: Talking North Carolina Medicaid on Plain Talk Politics | freeforall

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