by William C. Crawford

America is under constant siege by terrorists both foreign and domestic. Partisan politics has devolved to the point that some observers feel that the Republican Party is even practicing domestic terrorism.

Their rabid, irrational opposition to the Affordable Care Act, or ACA, and Medicaid expansion stand in stark hypocrisy to the true origins of Obamacare. This extremism seems to be sinking to the level of a prolonged, frightening attack on the working poor, job creation and the health of the hospital system in North Carolina.

Gov. Pat McCrory and the leaders of the General Assembly took a sworn oath to uphold the Constitution and the laws of the United States. The ACA was duly passed by Congress to provide health insurance to lower-income citizens. The law is working as more than 10 million Americans have gained coverage. However, Republicans ignore the success of Obamacare and they continually violate their oaths of office requiring them to follow the law. Instead of working to improve the ACA, Republicans strain to sabotage healthcare coverage for thousands of lower income citizens.

North Carolina has lost more than 25,000 jobs, which could have been created by Medicaid expansion. More than 400,000 of us still have no health insurance. We turn to the emergency room for costly, inefficient care. Hospitals are denied billions of dollars of available federal aid for indigent care because of Republican inaction. Large sums of our federal tax dollars are lost forever as they flow to more progressive states.

Republican opposition to Obamacare is particularly petty and partisan because it flies in the face of the law’s history. The ACA is largely a Republican creation. The simple facts are these: The law is broadly modeled on the extensive health insurance expansion enacted a decade ago by then Gov. Mitt Romney in Massachusetts. His advisors later gave important counsel to both the Senate and the White House as the ACA was developed.

Obamacare is largely dependent on private-sector insurance companies not a single-payer government entity. This approach clearly tracks proposals made by various Republican think tanks in response to the single-payer model suggested by Hillary Clinton in the early 1990s. Obamacare clearly embodies Republican free-market philosophy, and it was carefully crafted in close consultation with GOP members of the Senate Finance Committee and their allies — the hordes of insurance company lobbyists.

President Obama actually deserves little credit for the conceptual framework of the law. However, he courageously insisted that Congress draft healthcare reform, and then he threw the full weight of his presidency behind the initiative. The GOP quickly abandoned support of the legislation soon after it was drafted. They then pivoted diabolically to attack healthcare reform and almost everything else proposed by President Obama.

Gov. McCrory and the General Assembly should implement Medicaid expansion now. Expansion should become part and parcel of McCrory’s so called Medicaid reform. Three years of legislative wrangling should end with both phased-in reforms and incremental Medicaid expansion for the working poor. The White House has consistently signaled to Republican-controlled states that they will offer administrative flexibility to implement expansion quickly. A doctor-managed system holds much more promise than anything proposed by insurance companies, especially those from out of state.

The long lens of history may eventually recognize that Obamacare is mostly a Republican idea or at least an effective bipartisan initiative. We are a progressive, moderate state. It is time for the Republicans to honor and reflect that tradition. It is also time for them to remember that it is their sworn constitutional duty to uphold the law even when they don’t agree with it. Gov. McCrory and the General Assembly should shed their fearmongering mantle and protect the working poor, stimulate job growth and help our struggling hospital system.

William C. Crawford has 30 years of experience working in the Medicaid system. He also taught family policy at UNC School of Social Work in Chapel Hill. He lives in Winston-Salem.

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