Medicaid expansion a loser, say N.C. voters

by Dan Way, Carolina Journal, November 12, 2014.

More than half of North Carolina voters and 70 percent of Republicans would be less likely to re-elect Gov. Pat McCrory if he supported the expansion of Medicaid under Obamacare, according to a poll released today by the Foundation for Government Accountability.

“I think there are huge political consequences for Medicaid expansion that no one is talking about that this poll reveals,” said Christie Herrera, a senior fellow at FGA, a free-market research and advocacy organization based in Florida.

“The more that North Carolinians know about Medicaid expansion the less they like it,” she said, noting that voters also indicate they would be less likely to re-elect state representatives who support the expansion under Obamacare of Medicaid, the government health insurance program for the poor and disabled.

When asked about adding to the Medicaid rolls up to 500,000 people — primarily working age adults with no children or disabilities — 47 percent of North Carolina voters supported the proposition, and only 36.63 percent opposed it.

The poll found very different results when those surveyed were given more information about the potential consequences of Medicaid expansion.

Opposition to expanding Medicaid rose to 68.12 percent when respondents were told expansion would require $716 billion in cuts from seniors’ Medicare benefits; 67.13 percent were opposed after learning it would result in funding cuts to education, roads, and public safety; and 44.16 percent opposed it simply when they were told expansion was a key part of Obamacare.

The telephone poll taken Nov. 5 and 6 by Advantage Inc. surveyed a random sample of 500 North Carolinians who said they voted in the Nov. 4 midterm election. The margin of error was 4.38 percent.

McCrory is “taking a wait-and-see approach right now” about Medicaid expansion, spokesman Rick Martinez said. The governor and his staff have not seen the poll.

“I think [McCrory has] made it pretty clear that expanding Medicaid just to expand it under Obamacare, he’s not going to do that,” Martinez said.

“He has not indicated one way or another what he’s going to do other than he wants to make sure it’s a North Carolina-specific solution” to health care coverage among the uninsured, Martinez said. “He has not given any deadlines, he has not given any demands.”

State Health and Human Services Secretary Aldona Wos and McCrory recently have suggested the possibility of supporting Medicaid expansion.

But in recent years Medicaid has accumulated huge budget overruns, DHHS supervised the disastrous rollout of a new computer system designed to enroll participants and track payments, and questions remain about how large the backlog of unpaid bills and new signups has become.

The Republican-controlled General Assembly also has rejected Medicaid expansion, saying the struggling program faces too many problems to justify adding new burdens.

Political impact

McCrory could face substantial political fallout for expanding Medicaid.

“Seven in 10 Republican voters, his base, his bread and butter, say they are less likely to re-elect him if he expands Medicaid,” while 54 percent of all voters would be less likely to re-elect him, Herrera said.

“It’s actually even worse for legislators,” Herrera said. Eighty-two percent of Republican voters said they would be less likely to re-elect a lawmaker who supported Medicaid expansion, compared with 53 percent of all voters.

It is “not shocking” that North Carolina voters support Medicaid expansion when they believe it is “free money” from Washington, said state Rep. Hugh Blackwell, R-Burke, who sits on the House Health and Human Services Committee. Nor was Blackwell surprise that the polling flips “rather clearly and by substantial numbers” when they know it would have financial impacts on state taxpayers.

“My hope is that the governor will not stir this up again, and [Wos] won’t, and basically where we are is where I think the public, according to the poll, would like us to be,” Blackwell said.

“Secretary Wos is an admirable woman, but I think this is a case where sometimes it’s difficult for accomplished people to acknowledge that there are some things that even they can’t do,” and end up further expanding government in the process, Blackwell said.

“We need to design a program that puts individuals more in charge of their own health care, and not a smart secretary or a smart assistant secretary who comes up with just the right computer software program that can get you on the eligibility in record time, and can ferret out fraud in no time, and will pay all the providers within seven days,” Blackwell said. “It just is not happening.”

Nor has he seen any evidence that the health of Medicaid participants is improving, and DHHS, “in my judgment, has never managed to get on top of mental health reform.”

McCrory “wants to be responsive to a need, and the idea that a lot of folks have is ‘We’re just going to be better bureaucrats than the folks that we succeeded,’ ” Blackwell said.

“But the problem fundamentally is that I think that government is trying to do more than it should, and in the process is screwing it up,” he said.

Other states’ experience

Governors in 27 states and the District of Columbia expanded Medicaid. Some Republican governors who initially opposed expansion have reversed course or are considering it.

“What we’re seeing is Republican governors embrace Obamacare thinking they’re going to get a great deal, and they just get a raw deal,” Herrera said.

“I think that a lot of people are folding from pressure from special interest groups like hospitals, like insurance companies. … As these Republican Medicaid expansion plans unfold we see chaos,” Herrera said.

“We see Arkansas, where as soon as they began their Medicaid expansion, they were over budget,” Herrera said. Arkansas’ Republican-controlled legislature aligned with Democratic Gov. Mike Beebe to pass its plan.

In Pennsylvania, Republican Gov. Tom Corbett sought a work requirement when he expanded Medicaid. The feds rejected both that and his alternative pitch for a work search. Corbett lost his bid for re-election earlier this month.

Iowa Republican Gov. Terry Branstad expanded Medicaid with 10 waiver requests. “Nine were denied, and that 10th [waiver] he only got a reprieve for a year, and after the year the 10th thing is going to be denied,” Herrera said.

“Every newly elected United States senator said they wanted to repeal Obamacare,” and there were huge Republican gains in the House, Herrera said.

“This is not the time to be running towards Obamacare” when it’s “a fluid situation in Washington,” Herrera said.

“We don’t know whether Medicaid funding is going to be cut,” she said. “When both the Obama administration and Republicans say that one way to save money is to cut Medicaid funding to states, you know what’s going to happen.”

Martinez said Indiana is “one state that we’re keeping an eye on simply because it’s a very specific plan to solve very state-specific problems, and they need a bunch of waivers to make that thing work.” Indiana could serve as a test of the Obama administration’s willingness to give states flexibility.

But in the FGA poll, 66 percent of all North Carolina voters and 88 percent of Republicans opposed the Indiana model. Its most prominent feature is a POWER Account Plan that gives Medicaid benefits to working-age adults who have no children and are not disabled through a taxpayer-funded account. The federal government provides a set allowance to the state for new Medicaid enrollees, and state taxpayers must pick up all cost overruns.

The Arkansas plan is opposed by 63 percent of all North Carolina voters and 85 percent of Republicans, according to the FGA poll.

Arkansas’ signature feature is a private option allowing working-age adults with no children or disabilities to enroll in a mid-range silver plan on the Obamacare exchange without paying a premium. If the cost of coverage under the private option exceeds the subsidies offered by the federal government, state taxpayers make up the difference.

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