Spite can be a stubborn thing, and in the case of Medicaid expansion in North Carolina, it's proving stronger than compassion, logic and that usually all-powerful force - political self-interest.
North Carolina is one of a dwindling number of states - now down to 14 and almost all in the South - that refuse to expand Medicaid under "Obamacare." Holding Out is the new Lost Cause of the old Confederacy. It's a doomed determination to block expansion, mostly because it would broaden the signature accomplishment of President Obama.
Given the depth of Republican opposition, there is perhaps little point in again appealing to their compassion, logic and political self-interest, but here goes anyway.
The political base of the General Assembly's legislative majority is in rural North Carolina. Those areas are also where the opioid epidemic has hit North Carolina the hardest. Since 1999, more than 12,000 North Carolinians have died from drug overdoses. In 2017, drug overdoses from opioids and other drugs in North Carolina increased 22.5 percent over 2016, the second highest increase in the nation.
To ease this scourge in the places they represent, Republicans should support what is proving to be essential - Medicaid expansion. How much it can help was recently described in a remarkable New York Times report. The Times went to Dayton, Ohio, a city especially hard hit by opioid addiction, to see why deaths from opioid overdoses have dropped by more than 50 percent in the past year. Montgomery County, home of Dayton, had 548 deaths by Nov. 30 in 2017. Near the end of this November, the number was 250.
Several factors account for the reduction. The super-potent synthetic opioid fentanyl and its analogues are being used less in street drugs, and Narcan, a medication that can reverse an overdose, is now widely available. But Dayton Mayor Nan Whaley has no doubt about what has made the biggest difference. It's the very thing North Carolina Republicans are denying their own hard-hit counties.
In 2013, Ohio Gov. John Kasich pushed past a reluctant legislature to expand Medicaid under the Affordable Care Act. It has given more than 700,000 low-income adults access to free treatment for addiction and mental health problems.
"It's the basis - the basis - for everything we've built regarding treatment," Whaley told The Times. "If you're a state that does not have Medicaid expansion, you can't build a system for addressing this disease."
In North Carolina, expansion would provide health insurance for 339,000 uninsured adults. The federal government would pay at least 90 percent of the cost.
Opioid addiction affects more than addicts. It's also pushing more children into foster care. According to a report by NC Child, the incidence of parental substance abuse as a contributing factor to children entering foster care has increased 50 percent since 2007. It was a factor in 39 percent of new cases since 2016. The problem is especially acute in western North Carolina. While the state has seen a 15 percent rise in foster care children since 2010, western counties have experienced a 56 percent increase.
Tammy Shook, Buncombe County's recently retired social services director, told the Asheville Citizen-Times earlier this year, "In my opinion, we are creating a lost generation of children who are going to be without their biological parents because of this epidemic."
North Carolina must address the opioid crisis on several fronts, including reducing the over-distribution of pain medication, spreading warnings about fentanyl and protecting the children of addicted parents. But the most powerful step it should take is to expand Medicaid to give more opioid abusers access to the physical and mental health care they need to get off the drugs.
Lives depend on it. It's working in Ohio and other states. It can work here.
Visit The News & Observer (Raleigh, N.C.) at www.newsobserver.com