North Dakota Gov. Jack Dalrymple, who was among a handful of Republican governors to sign on to Medicaid expansion under the Affordable Care Act, did the right thing. He took a lot of political heat from his own party, but resisted. He not only was right at the time, he since has reiterated that it was the right thing to do for North Dakotans who did not have access to health care.
The governor is no cheerleader for Obamacare. He is, however, a pragmatic leader who saw an opportunity to help North Dakotans in need, and made the call. The results thus far confirm his foresight.
Some 19,000 North Dakotans have signed up for health insurance under the ACA's Medicaid expansion. The program is a major factor in the steep decline in uninsured people in the state. It's not the only factor (a strong economy and competitive job market are causing more employers to offer health policies to workers), but it is a significant driver of the state's good health insurance statistics. The drop from 15 percent uninsured prior to the ACA to 6.9 percent this year is one of the more impressive changes in the nation.
Critics contend the Medicaid change is proving to be more expensive than forecast. No surprise. However, the charge that Obamacare is the primary cause of escalating health insurance and Medicaid and Medicare costs is mostly canard. Health care inflation was raging before Obamacare, still is, and would have been showing the same trends had the ACA never become law. What the ACA has done, unfortunately, is give insurers and health care providers cover for rising costs. Every time rates go up, co-pays rise or the cost of a drug jumps, they conveniently and dishonestly point to the ACA as the culprit.
Polls show Obamacare, the concept at least, remains unpopular among most Americans. But break it down and ask about specific provisions - expanded Medicaid, insuring existing conditions, keeping kids on a policy longer - and poll results flip.
Certainly there is lots not to like about the ACA. But insurers and providers have moved quickly to adjust to the law's new reality. And governors like Dalrymple, who was able to cut through the partisan smog, helped make affordable health care accessible.