Governor Pat McCrory is doing his best to wreck Medicaid in North Carolina, with loads of help from State House Speaker Thom Tillis and the GOP majority in the General Assembly.

Their refusal to accept the Medicaid expansion permitted under Obamacare has denied 377,000 people coverage and forfeited multiple billions of federal dollars. It has arguably cost 20,000 jobs that would have been created as well. Fortunately our well-organized nonprofit organizations have pushed back hard and helped to assure citizens of the coverage they need and deserve, both through government programs and private insurers.

Despite the GOP’s refusal to create a state-level insurance exchange and refusal to accept that federally funded expansion of Medicaid, North Carolina is way ahead of other “states of denial” by many measures. Almost 108,000 citizens have signed up for private insurance under Obamacare, the highest per capita rate of any “refusenik” state. And in utter contradiction of McCrory’s repeated claims that our state’s Medicaid system is “broken” — it is working almost impossibly well. As Medicaid spending per person has climbed 6 percent nationally since 2008, it has fallen 11.6 percent here, thanks in large part to the managed care program, Community Care.

North Carolina Community Care Networks Inc, (NCCCN) is a public-private partnership. It is a statewide umbrella organization that represents and supports 14 regional networks in designing and implementing care improvement initiatives for Medicaid recipients and other under-served populations. As noted by Adam Searing, director of the Health Access Coalition of the N.C. Justice Center, “Under Community Care, local doctors, hospitals, health centers, health departments, social service offices, legal service providers and other community leaders have been quietly working together every day, every month and every year for a decade to help people access and use health care.”

This well-established organization was ready and able to help our state’s citizens work through the federal health insurance exchange to sign up for both coverage and the federal subsidy available to low income subscribers.

One of the amusing, ironic and surely unintended results of the GOP-led refusal to participate in Obamacare (which resulted in North Carolina and 26 other states declining to set up state exchanges) is that the federal exchange is now seen as enormously successful. While the federal Web site got off to a bad start, once the problems were ironed out it started to work remarkably well. Some of the states which did set up their own exchanges are now opting to switch to the federal system (Oregon first among them, as their state program was beset with problems.)

What we see now is that the federal system is laying the organizational groundwork for a nationwide single-payer system. There will be huge resistance from the right, but the demographics favor universal health care in the long run. Millennials are strongly in favor of single-payer according to poll results. A decade or so from now we are very likely to see widespread electoral support for “Medicare for All.” 

Moreover, Vermont has chosen an option in the Obamacare plan that permits states to set up their own single-payer systems. The Vermont experiment will be closely watched as it comes on line in the next few years. Success there is very likely to infect the rest of the country with the idea that high private insurance rates which go to support excessively paid CEOs and advertising departments are not the best use of health care dollars.

The GOP in North Carolina is fighting a rear-guard action, urgently attempting to roll back the calendar to the state’s pre-WWII status as just another backward, southern plantation. But their redistricting schemes, their slashing of education and health care budgets, their hobbling of environmental regulation and tax cuts for the wealthy will prove temporary at best.

The fact that doctors and hospitals are making Medicaid work better here than anywhere else in the country is just one progressive element in a state that has changed radically since the Dixiecrat past. 

Young voters, relocated elders from the northeast and west coasts, a shrinking white majority and the influx of high-tech employers all point to a long term shift away from the current General Assembly majority.

Cecil Bothwell, author of nine books, including “She Walks On Water: A novel” (Brave Ulysses Books, 2013), is a member of Asheville City Council.