Cooper Makes a Colossal Blunder

By John Hood | Jan 08, 2017

RALEIGH — Roy Cooper spent his last few weeks as governor-elect of North Carolina attacking the state legislature for encroaching on the separation of powers, weakening the rule of law, subverting the will of the voters, and hurrying new policies through too quickly, without adequate discussion or consultation.

Roy Cooper then spent his initial few days as governor of North Carolina doing precisely what he’d accused the legislature of doing — and giving himself an unnecessary black eye.

Cooper’s first big mistake involves the same issue that severely damaged Barack Obama and his administration: the Affordable Care Act. The president came into office determined to expand government control of health care. He spurned contrary views and pushed through what he wanted. The public didn’t like it. Obamacare is the single-biggest reason why the Democratic Party is at its weakest point since the 1920s.

But progressives remain convinced that policy success and public approval are just around the corner, and that Republicans won’t repeal and replace the ACA’s core policies of Medicaid expansion and government-run insurance exchanges. I don’t know if Cooper agrees with them or believes he has no choice but to indulge the fantasies of his political base. I do know the decision he announced on January 4 — to seek Medicaid expansion in North Carolina through executive action — is a colossal blunder.

Republican lawmakers have passed multiple laws to forbid Medicaid expansion without their approval. They get to do that. Medicaid expansion requires a state appropriation to match federal dollars, regardless of how that appropriation is funded (through general revenues or taxes on hospital bills). It is also a policy matter about which the legislative branch has constitutional authority, as House Speaker Tim Moore and Senate leader Phil Berger have already informed the outgoing Obama administration.

I don’t see any way for the ensuing legal dispute to end well for the governor and Democrats. Either the North Carolina Supreme Court will confirm the obvious and deny Cooper the arbitrary power he claims to have to change state policy and appropriate state funds. Or, having just shifted from a 4-3 Republican majority to a 4-3 Democratic one, it will issue a dishonest opinion that will seem far partisan than anything the GOP-majority court ever did — while still not giving Cooper an actual win on Medicaid expansion.

How come? Because by the time such a decision is rendered, there won’t be an Obama administration to play with. The Trump administration is hardly likely to approve a Democratic governor’s scheme to circumvent the will of a Republican legislature. Moreover, the Republican Congress will likely reform Medicaid in ways that will make the dispute moot, either by forestalling expansion altogether or by rewriting the rules in such a way that state Republicans may decide to accept somewhat-broader eligibility rules in exchange for spending caps, flexibility, and private options.

By claiming unilateral authority to expand Medicaid, Gov. Cooper destroyed the political narrative he and his progressive enablers in the media had created after the 2016 election. Whatever you think of the Republican legislature’s decisions to reduce the number of political jobs Cooper can fill, strengthen the role of the state superintendent of public instruction, or combine the state’s ethics and elections boards, they don’t constitute a large-scale change in public policy. They don’t seek to obligate the state to spend billions of dollars without legislative approval.

The governor’s Medicaid gambit encroaches on the separation of powers, weakens the rule of law, and subverts the will of the voters who have elected a Republican president and Congress to take health care policy in a different direction. It also represents a major policy change hatched without adequate discussion or consultation, thus alienating even longtime advocates of Medicaid expansion such as the state hospital association who want bipartisan action.

I criticized Republicans in the legislature for acting too hastily during the December special session. Will the Left criticize Cooper for acting too hastily on his first week on the job? I won’t hold my breath.

John Hood is chairman of the John Locke Foundation and appears on the talk show “NC SPIN.” You can follow him @JohnHoodNC.

Comments (2)
Posted by: Charles Zimmerman | Jan 09, 2017 10:36

From Gov. Cooper's press statement:

“This is North Carolina common sense,” Cooper said. “We can receive between $3 billion and $4 billion to pay for care that hospitals and other providers now give away. That will create jobs, bolster our hospitals, could save some rural hospitals and work toward more stable private insurance premiums.”

Right now, North Carolina tax dollars are going to Washington, where they are being redistributed to states that have expanded Medicaid. Why should North Carolinians pay for Medicaid expansion in states like New Jersey, Ohio and Indiana when we don’t even expand it to our own people?”

From: http://governor.nc.gov/news/governor-cooper-tells-washington-north-carolina-will-seek-expand-medicaid

 

RALEIGH
Jan 6, 2017

Gov. Roy Cooper served notice today that he is seeking federal approval that would allow the state to cover more uninsured North Carolinians through Medicaid.

Cooper, who has called for broader health care coverage by expanding Medicaid, sent a letter to the Centers for Medicare & Medicaid Services (CMS) in Washington. If CMS approves a change, if local matching money can be secured, and if state eligibility requirements are changed, then more than a half-million North Carolinians could receive health care beginning in January 2018.

“This is North Carolina common sense,” Cooper said. “We can receive between $3 billion and $4 billion to pay for care that hospitals and other providers now give away. That will create jobs, bolster our hospitals, could save some rural hospitals and work toward more stable private insurance premiums.”

The NC Hospital Association says the state’s hospitals provide about $1 billion in care annually to residents who cannot pay for it. Hospitals would receive a significant share of additional Medicaid dollars that would come back to the state under Cooper’s plan. Cooper believes the contributions can be paid through a combination of savings in existing state expenditures due to the new federal funding and a local matching contribution. Hospitals would contribute a 5% local match that CMS requires. Depending on how many additional residents enroll in the expanded program, the hospitals’ contribution could be between $100 million and $150 million in the first year.

The Cooper Administration says that a 2013 state law that prohibits the governor from seeking to provide health care for low-income North Carolinians does not apply to this draft plan.

“Right now, North Carolina tax dollars are going to Washington, where they are being redistributed to states that have expanded Medicaid,” Cooper said. To date, 31 states and Washington DC have expanded coverage through Medicaid; in 2016 these states received more than $70 billion in federal funds. “Why should North Carolinians pay for Medicaid expansion in states like New Jersey, Ohio and Indiana when we don’t even expand it to our own people?”

The state will accept comments for 10 days on North Carolina’s notice of intent to amend its Medicaid plan. The Cooper Administration then will file a State Plan Amendment with CMS.

Links to the documents filed today are available on the North Carolina Department of Health and Human Services website under Alternative Benefit State Plan Amendments (Medicaid expansion).



Posted by: Bill Collins | Jan 09, 2017 13:14

Cooper is a skilled and experienced politician that has a balanced view of what is needed for ALL NC citizens.  I applaud his efforts to understand (like John Kasich in Ohio):

1. the value of the  revenue that NC would receive with NC Medicaid expansion

2. balanced with supplying critically needed healthcare for certain NC citizens

3. while reducing hospital uncompensated care that otherwise increases our NC employer healthcare plan costs.

Maybe our new Republican Congress and President will (finally) repeal the ACA but it just may take longer than desired to come up with an appropriate replacement.  So in the interim, it's my opinion that our duly-elected Governor, Cooper is doing what is best for ALL NC residents and taxpayers.



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