Missed opportunity on Medicaid a defining issue of the legislative session


By Chris Fitzsimon - N.C. Policy Watch



One of the biggest stories of the 2015 General Assembly is what lawmakers didn’t do and the people they didn’t help.

They again declined to follow the lead of 30 other states and the District of Columbia and expand Medicaid under the Affordable Care Act and provide health care coverage for as many as 500,000 low-income adults, create thousands of jobs, and help struggling rural hospitals across the state, two of which have already closed or have announced they are closing.

Lawmakers never seriously considered expanding Medicaid even though the federal government would pick up most of the cost and Governor Pat McCrory never encouraged them to, never proposing a plan like many fellow Republican governors across the country have done.

McCrory has waffled mightily on Medicaid expansion, even as officials in his own health and human services department have publicly discussed presenting him “options for expansion.”

The options have never been revealed and McCrory has never explained them, though he has said several times he wanted a North Carolina plan not a Washington plan.

Other Republican governors have worked with federal officials to develop a state-specific expansion. McCrory has only talked about it.

It’s not like Medicaid wasn’t on the agenda this legislative session.

Lawmakers spent months working behind the scenes on a Medicaid “reform” proposal, misstating and mischaracterizing the challenges with the current system to justify a phased-in privatization plan that will turn over much of the care of the most vulnerable people in the state to out-of-state for-profit managed care companies, a scheme that has created problems in states that have tried it.

Advocates tried to make expansion part of the discussion but the ideology of legislative leaders wouldn’t allow it. It’s part of “Obamacare” after all and the folks currently in charge of the General Assembly dislike President Obama more than they care about providing health care for hundreds of thousands of people who can’t afford it.

That leaves Governor McCrory to play the role of the adult in the room but so far he doesn’t seem up to it. His waffling comes in face of overwhelming evidence of the benefits of crafting a Medicaid expansion plan.

A report released this summer in the middle of the troubling reform discussions by the Georgetown University Center for Children and Families and NC Child found that 27 percent of the people in North Carolina who would benefit from expansion are parents with children in the home.

You think legislative leaders who claim to being committed to helping families would respond to that.

They also talk often of economic development as a priority. A study a few years ago by the N.C. Institute of Medicine found that Medicaid expansion would create as many as 23,000 jobs over the next 10 years. It will help rural communities by bolstering their struggling hospitals with an infusion of federal funding.

The case for expansion is overwhelming. That’s why 30 states have already done it, including Ohio, where Republican Governor and presidential candidate John Kasich led the effort.

The window hasn’t closed on North Carolina’s chances but the McCrory Administration needs to step up soon. The misguided reform efforts passed this session may give them another opportunity.

The state needs waivers from the Obama Administration to implement the new Medicaid system and that might take a while. The process could go more smoothly if officials also include an expansion plan as part of their waiver requests.

Plus it’s the right thing to do for the economy, for hospitals and communities, and for half a million people still struggling to see a doctor. Let’s get on with it.

Chris Fitzsimon is the Founder and Executive Director of N.C. Policy Watch

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By Chris Fitzsimon

N.C. Policy Watch

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