Medicaid expansion comes knocking again in NC. This time it’s a better deal.
The gridlock over expanding Medicaid in North Carolina – an impasse now entering its seventh year – can get tiresome, but fortunately for the state’s working poor it’s an issue about which Democrats are tireless.
Gov. Roy Cooper vetoed the last state budget passed by the Republican-led General Assembly in part because it did not provide for expanding Medicaid, a change that would mostly benefit low-income working adults without children. Now President Joe Biden is making a pitch to North Carolina and 11 other holdout states in an effort to extend health insurance to millions of people who are braving the pandemic without it.
Biden’s $1.9 trillion COVID-19 relief package has passed by the House and is awaiting a Senate vote.. The plan provides an incentive for states to expand Medicaid by temporarily increasing federal Medicaid payments by 5 percent for two years for states that newly expand Medicaid..
Rather than taking on a new expense, most states that have expanded have actually seen their revenues grow as expansion created thousands of health care jobs and generated increased tax payments by health care providers. Meanwhile, states have saved money by paying hospitals less for uncompensated care.
North Carolina Republicans opposed to expansion are running out of reasons for turning down billions of federal dollars that could provide health insurance for half a million North Carolinians.
The initial resistance was based on opposition to the Affordable Care Act, which provides for expansion. But the calls to “repeal and replace” the ACA have faded since President Donald Trump failed to end Obamacare. With a Democratic administration in power and the ACA now favored by a majority of Americans, the law is not going away.
Republican concerns about the federal government reneging on its commitment to pay 90 percent are unfounded. The federal government has stood by its payment agreement since the ACA took effect in 2014. In any case, North Carolina legislation expanding Medicaid could include an escape provision should federal support decline.
Republicans now cite another objection – that an influx of new people on Medicaid will crowd out care for disabled people already covered by the program. Matthew Buettgens, a health care policy analyst at the Urban Institute who has closely followed Medicaid expansion, told the Editorial Board that the change has not swamped doctors who treat Medicaid patients.
“There were concerns that it was going to flood health care providers, but that has not happened,” he said.
Leighton Ku, the lead author of the 2014 study “The Economic and Employment Benefits of Expanding Medicaid in North Carolina” was unable to penetrate Republican opposition. In a 2019 update to the study, the professor of health policy and management at George Washington University estimated that expansion would create 37,000 new health care jobs and pump about $11.7 billion in federal funding into the state economy in the first three years while providing insurance to approximately 365,000 more people..
Last week, Ku said logic is not persuasive in the states where Republicans are holding out. “My impression is that most of the opposition is essentially partisan,” he said. “Republicans say, ‘Obamacare is the devil’s work and we want nothing to do with it.’ ”
But when it comes to Medicaid expansion, there is no devil in the details. The closer you look, the more sense it makes. That’s not lost on North Carolinians, a majority of whom support expansion. Now Biden wants to improve the deal.. If the provision survives a Senate vote, North Carolina’s Republican lawmakers should, at long last, accept the offer.
Correction: An earlier version of this editorial incorrectly described President Biden’s proposed incentive to expand Medicaid. For two years, It will increase the federal share of all Medicaid funding by 5 percent for states that expand, not just the share for covering people newly enrolled under expansion.
