It might be some time before we know conclusively how the Supreme Court’s ruling affects our nation, the healthcare system or our citizens, but we can speak to some of the impact it will have in North Carolina.
There are an estimated 1.5 million people who do not have health insurance in our state. If the Affordable Care Act is allowed to take affect, as affirmed by the Supreme Court, these citizens will be required to choose a healthcare insurance plan no later than 2014. Some will enroll in a health insurance program or the state exchanges that the law mandates. Some will choose to pay the fine (or tax) rather than submit to payment of health insurance premiums. But as many as 600,000 of the 1.5 million will choose Medicaid, creating problems on two fronts.
The first and most obvious is the cost factor. The law, as written, has the federal government picking up 90 percent of the cost at first, with the states ultimately having to absorb about 1/3 of the costs in the next five years. This escalating cost could add 300-900 million dollars per year to our state’s budget. North Carolina’s Medicaid program already expends 9 billion dollars, about 3 billion of which comes from our 20 billion dollar state budget. If the ACA plan goes into affect in 2014 this could add another billion dollars per year to our budget within the next five to six years and legislators would be forced to either raise taxes to cover the outlay or restrict services to our state Medicaid plan.
But the more important problem involves what our healthcare systems will do in trying to deal with so many new patients. We are not currently equipped to deal with these numbers, according to former DHHS Secretary Lanier Cansler. This will put strains on our system we cannot even envision and could delay healthcare services.
Most everyone believes the current version of the ACA will be modified before the individual mandate takes affect in 2014, with Republicans vowing to repeal it. The real answer is that nobody really knows the impact this verdict will have on our state. One thing is sure. NC SPIN will present a balanced debate about its impact