It was easy to lose in the ongoing rumors surrounding the State Department, but President-elect Donald Trump made a major announcement for the future of the federal health care system on Tuesday. He selected U.S. Rep. Tom Price, R-Ga., to become the next secretary of health and human services.
It’s a long title for a little-known congressperson, but his nomination suggests that Trump will make good on his promise to destroy the Affordable Care Act and possibly restructure Medicare and Medicaid. Price has been a strong opponent of the ACA, and as a doctor, he originally got into politics to facilitate a privatized vision of medicine.
The ACA was far from a perfect bill. Almost no one believes the best version of U.S. health care looks like “Obamacare.” However, North Carolina has seen how rejecting any health care expansion can harm a state, and it needs to be on the forefront of creating viable health care options for all of its residents.
N.C. has had a mixed relationship with the ACA in the past. Despite having one of the highest ACA enrollment rates in the country, the N.C. General Assembly rejected the state’s Medicaid expansion. This meant that N.C. refused over $20 billion in federal health care funding, which directly resulted in over 500,000 people not having health care. It helped cause a health care system where thousands of jobs are constantly at risk and 16 rural hospitals at least 35 miles from the next closest hospital are at high risk of closure.
The people at risk under these health care failures are those most likely to need health care. The working poor, people of color, rural North Carolinians and permutations of the three are all more likely to need health care and have been most disadvantaged by the system’s failures.
The future of our system cannot replicate this past, and with the coming destruction of the ACA, the solutions of the present won’t be feasible after Jan. 20. Presumptive governor-elect Roy Cooper expressed an interest in expanding Medicaid under the ACA, but the future of health care in N.C. will be decided on new fronts. Expanding access, decreasing cost and ensuring quality care will continue to be priorities, but instead of relying on the framework of the ACA, Cooper will need to help craft new state-specific legislation.
Such efforts might include setting limits on cost, creating state marketplaces to expand care, or reforming quality standards for N.C. Bipartisan efforts to accomplish similar goals have failed in the past in part because of partisan political objections to the ACA. Hopefully, N.C. legislators will move past partisan labels and create a health care system in our state that does more to support all its residents.
If not, we need to hold them accountable through advocacy networks like the North Carolina Justice Center’s Citizens for Responsible Health Care. Health care in America continues to be broken, but N.C. should come together to start fixing it.
