Medicaid expansion and McCrory’s list of regrets and resolutions

by Chris Fitzsimon, NC Policy Watch and NC SPIN panelist, December 3, 2013.

When Governor Pat McCrory sits down in the next few weeks to consider his first year in office and gets around to listing his regrets about 2013 and his plans for 2014, both ought to start with the same thing, expanding Medicaid in North Carolina.

McCrory and his Republican colleagues in the state House and Senate made the decision to refuse Medicaid expansion early in the 2013 legislative session despite compelling reasons for expansion, most importantly the opportunity to provide health care coverage for 500,000 low-income adults who are currently uninsured.

The federal government would have paid the full cost of the expansion for the first three years and more than 90 percent of the tab after that.  Medicaid expansion would have brought in $13 billion dollars for hospitals over the next ten years and created as many as 25,000 jobs in the state, according to a study by the N.C. Institute of Medicine.

But legislative leaders had already made up their minds before considering any of the facts. Their decision was motivated by ideology not policy disagreements. They dislike President Obama more than they want to help people who are uninsured be able to see a doctor.

McCrory at first seem troubled by the rash decision, asking the state Senate to delay passing legislation to refuse the expansion, a request Senate leaders completely ignored.

The bill declining the expansion also included the decision not to set up a state insurance exchange under the ACA, forcing North Carolina consumers to use the federal exchange and to look to Washington for assistance with the enrollment process instead of down the road in Raleigh where Insurance Commissioner Wayne Goodwin was preparing to help.

Not surprisingly, the enrollment process has been much smoother in states like Kentucky that chose to set up their own state exchanges, but enrolling people was never the goal of lawmakers in North Carolina—making a political statement about President Obama was.

Many other states, including several with conservative Republican governors, decided to ignore their philosophical opposition to the Affordable Care Act and put their constituents first and expand Medicaid.

Ohio Governor John Kasich, a Republican and staunch conservative, justified his decision to expand it very simply, saying “it’s going to save lives.” Not in North Carolina.

McCrory has since defended his decision by repeating ad nauseam that Medicaid is North Carolina is “broken,” plagued by cost overruns and extraordinary high administrative costs.

Neither is true. The legislature’s own staff recently concluded that an audit earlier this year vastly overstated the administrative costs of the program and that North Carolina’s Medicaid program was actually operating with lower overhead costs than neighboring states.

Community Care of North Carolina, the state’s homegrown nonprofit managed care organization that is a key part of the state’s Medicaid program, has won numerous awards including one presented by North Carolina’s Republican Senator Richard Burr.

But McCrory has also occasionally expressed some hesitation about his decision not to expand Medicaid, not doubts exactly, but hesitation nonetheless.

He recently told the Charlotte Observer that he was continuing to evaluate the decision and oddly at an event in Washington in October he said that North Carolina might be forced to expand it.  No one is sure exactly what he was talking about, but the issue is clearly on his mind.

If McCrory does come to his senses in 2014 and convinces the General Assembly to expand Medicaid, the federal government would still pay the full cost for two years and more than 90 percent after that.

And most of those jobs would be created too. That would be welcome news, especially at hospitals across the state that are laying people off because of the decision to reject Medicaid expansion.

And most importantly, as many as 500,000 low income adults would be able to see a doctor when they need to.

What do you say Governor? How about a New Year’s resolution to do the right thing and save some lives in North Carolina?