No one expected North Carolina’s Republican governor and North Carolina’s Republican majority in the General Assembly to agree on everything; but in the first week of the legislative session, the like-mindedness has dissolved into a difference of opinion on how to proceed with a Medicaid program destined to change under federal health-care reform.
Moving quickly, if not impulsively, Republicans in the state Senate voted Tuesday to block Medicaid expansion allowed under the Affordable Care Act — intent, they said, on sending Washington a message. Gov. Pat McCrory had asked they delay a vote while he read the act’s fine print, fearing a block would jeopardize Medicaid-related payments to the state.
Thankfully, Republicans in the state House say they will proceed more deliberately on the bill, perhaps giving McCrory time to catch up to and influence the debate, but likely not changing the state’s position. House Republicans are no less interested in telling the Obama administration what they think of Obamacare.
“Expansion” is the kind of word that elicits a reflexive response from small-government Republicans, especially when it’s linked to one of the biggest big-government programs since the New Deal. However, seeing a revamped Medicaid program as part of the inevitability of the Affordable Care Act — that it is now law and the framework of a system designed to work best for people who are insured — could also reveal some value in it, even to conservatives.
Nationally, five Republican governors, including Ohio conservative and Obamacare opponent John R. Kasich, have sided with expansion as a way to reduce costs associated with uninsured people who use the emergency room for primary care. That “free” care raises health-care costs and patients who are insured get the bill.
Expansion involves some big numbers. Covering anyone making 138 percent of the federal poverty level or less — about $31,000 for a family of four — would make another 648,000 low-income North Carolinians eligible; the state estimates some 500,000 of them would enroll, most of whom now have no insurance. Legislators who vote to limit access of these people to insurance have to consider the impact of that action and alternatives to simply leaving them out of the system.
Cost can’t help but be a consideration. North Carolina’s Medicaid program, the second largest program in the state’s budget, is one of the most expensive in the Southeast and is badly need of reform. It’s inefficient, provides too many optional services and spends too much on long-term care. Yet, instead of reform, Republicans offer obstinacy.
The federal government plans to pay 100 percent of the cost of Medicaid expansion for the first three years and 90 percent thereafter. Senate Republicans said they don’t trust Washington follow through on that promise. What they meant was they don’t want to have anything to do with Obamacare.
In taking up the bill, legislators in the House have the opportunity to find some middle ground or, better yet, plow new ground through reform. They can look into the data state-paid consultants used in predicting extra Medicaid funds would add about $1.4 billion to North Carolina’s economy and add about 23,000 jobs. They can mull the consequences to community hospital like Lenoir Memorial if the uninsured poor aren’t covered through Medicaid or some alternative plan. The can weigh their feelings about aiding and abetting the growth of government
They can forget sending a message to Washington and send a message to North Carolinians instead. They can say, We’re doing our job.