By Kirk Kovach

What’s the matter with Kansas?

That’s the title of a popular book, and a now-popular phrase. In the past 20 years, the conservative strain of anti-establishment populism ascended to power. This experiment in Tea Party conservatism culminated with massive tax cuts signed into law by former Kansas Gov. Sam Brownback, a Republican.

“Our new pro-growth tax policy will be like a shot of adrenaline into the heart of the Kansas economy,” Brownback said.

The results were not so rosy. Within five years, Republican legislators bucked their own governor, repealing the tax cuts that constrained the state’s ability to fund necessary services and, contrary to its stated goal, resulted in a slowdown of economic growth. Not great.

In the last gubernatorial election, controversial candidate Kris Kobach captured the Republican nomination. He carried plenty of baggage, but one of his platform planks included doubling down on the austerity disaster in the Brownback experiment. A Democrat, Laura Kelly, now serves as governor. 

Kelly and Republican legislative leaders in Kansas were able to reach a deal on expanding Medicaid, bringing coverage to thousands of working poor. 

When Medicaid expansion was first offered as an option, Republican-leaning states almost reflexively opposed accepting any federal funds for government-managed health care. A few years on, though, the deal started making more sense, even for conservative legislators who allegedly opposed the prospect on ideology.

In fact, it seems hard to refute what amounts to a steal for states: In North Carolina, if it were to expand Medicaid, the cost of coverage would not be borne by taxpayers. An estimated 90% of the funding would come from the federal government and the remaining fees would be collected from health care providers.

The benefits don’t end there. Whereas the Kansas experiment in taxes hurt their economy with no discernable impact on the job market, studies demonstrate that Medicaid expansion would actually create tens of thousands of jobs, particularly in the health care field. 

If talk of Kansas has bored you, this column is actually about North Carolina. We find ourselves in a similar predicament: A conservative legislature that is focused more on tax cuts than investments in our state and a Democratic governor in Roy Cooper fighting for Medicaid expansion.

Republican leaders have chosen not to budge, even though their constituents are poised to benefit the most from Medicaid expansion. Despite the cost of expansion remaining $0 and despite countless Republican legislators in deep-red states across the nation — Arkansas, Utah and Louisiana (Go Tigers) — and others choosing to expand Medicaid, North Carolina Republicans choose not to.

Clearly, the battle on Medicaid expansion has been fought and lost. Those words are not my invention; they were spoken by Phil Cox, the former head of the Republican Governors Association.  

At this point, Republican caucuses in the North Carolina General Assembly are treading water with regard to Medicaid expansion. It’s less a question of whether it will happen, but when and in what form. Instead of keeping it as some sort of carrot hanging above the budget negotiations as a possible separate discussion, Medicaid expansion should be table stakes. 

Most of its opponents are in ruby-red seats with no fear of a Democratic opponent. The real competition comes in the form of primary opponents — someone running further to the right. If the members are more concerned with winning a primary than with the health and wellness of their constituents, it raises the question: Whose interests do they really serve?

Kirk Kovach is a Rowan County native and writes for politicsnc.com.