Some good news

 North Carolina took a giant step today in the right direction. Their state legislature finalized a bill to expand Medicaid under the Affordable Care Act (ACA) to otherwise ineligible people earning up to 138 percent of the federal poverty level. It is estimated that this will benefit around 600,000 people.

But it's not just about health coverage. The expansion will bring in millions of federal dollars, create jobs, keep rural hospitals open, help people recover from Substance Use Disorder and all kinds of other good stuff.

By my count--and counting has never been my strong suit--North Carolina is the 41st state, including DC, to take this step. It's especially important that this happened in a southern state. Let's just say that if one was drawing a Venn diagram of states that resisted expansion with states that belonged to the Confederacy there is considerable overlap. At the risk of extreme understatement, this might not be entirely coincidental. But every time this happens, it puts more pressure on the holdouts to do the right thing.

A little review: Medicaid expansion was intended for all states and DC when the ACA was passed in 2010. A 2012 US Supreme Court decision upheld the constitutionality of it, but made expansion a state decision. Depending on the state, the decision could be made by ballot measure, executive decision, or legislation, which is always more complicated.

We were lucky that West Virginia's decision was made before the state turned into a ________ (you can fill in the blank) by my favorite all time governor, Earl Ray Tomblin. The state agency in charge did a fantastic job of signing people up. Lots of people I know worked really hard to make sure that happened. I'm not sure of the current enrollment numbers, but at times it has come close to 200,000 adults in a state with a population of 1.8 million, more or less.

However, we had to spend a lot of years defending it, especially during the Orange Epoch, when the late Senator John McCain, to his great credit, stopped efforts to repeal it in the senate. West Virginia was in the hot seat then too, with a conservative Democrat and a fairly moderate Republican in the persons of Joe Manchin and Shelley Moore Capito. Manchin took a "fix not nix" approach and Capito said that she "didn't go to Washington to hurt people."

Then there were state legislative efforts by out of state groups like ALEC and the Foundation for Government Accountability to impose bureaucratic hoops and reporting requirements designed to cut people off as recent as this year, which were fortunately defeated. It also was a huge relief when the US Supreme Court (!) effectively squelched efforts to undo the law in 2021.

I imagine folks in North Carolina will have to be vigilant on the enrollment process and ready to defend the expansion when efforts are made to weaken it. But it's still a great day.

Next stop...maybe Alabama? Sometimes the domino theory has its moments.

Why we can't have nice things...and how to change that

Philip of Macedon.

People in positions of wealth and power have known the secret of keeping it since ancient times: divide and rule. That statement has been attributed to Phillip of Macedon (382-336 BC), father of Alexander the Great, as well as Julius Caesar (100-44 BC), but the idea was probably already old in their day.

The saddest thing, however, isn't that the rulers do it to us. It's that we do it to ourselves.

Let's look at some real and recent examples in the wake of West Virginia's historic and successful teachers' strike:

*some advocates for the poor were perplexed at the show of support for "middle class" teachers and the apparent lack of concern for those who were worse off.

*some education workers I know have said disparaging things about low-income people who rely on SNAP (food stamps) and Medicaid expansion, apparently not realizing that the same people who target poor people also target public education.

*some people who buy health coverage on the exchange at high prices or who have other poor and expensive insurance may look askance at people on PEIA, asking why tax dollars should be spent on health care for public workers.

And so it goes. Like crabs in a bucket, we pull each other down.

If you want to think of how this plays out on a grand scale over history, think about how people have been divided over race, ethnicity, religion, sex, national origin, etc. And who wins when this happens.

This is why we can't have nice things. So far. As Cassius said in Shakespeare's Julius Caesar,

 “The fault, dear Brutus, is not in our stars / But in ourselves, that we are underlings.”

Getting past that will require developing a culture of solidarity rather than division. It won't be easy, but I don't think there's any other way forward.

Once again, a bright spot can be found in the nationwide teachers' uprising that began right here in WV. When teachers flooded North Carolina's capitol in protest, their demands didn't just include raises for teachers and more funding for education. They also called for expanding Medicaid for low income North Carolinians.

Todd Warren, president of the Guilford County Association of Educators, was quoted in VICE News as saying, “We think that that's not only the correct and the moral thing to do, but as educators, our students' well-being and their literal health comes first.”

That's an example of the kinds of bridging that needs to happen if we're going to get out of the mess we're in.