NC attempts to block Medicaid expansion
Who is eligible for Medicaid under the Affordable Care Act?
As of Jan. 1, 2014, Americans under 65 who earn less than $14,000 for an individual and $29,000 for a family of four will be eligible to enroll in Medicaid. States will receive 100-percent federal funding for the first three years to support this expanded coverage, phasing to 90-percent federal funding in subsequent years.
North Carolina Senate Bill 4, which would block the federal Medicaid expansion for the state, is still being discussed by the General Assembly.
The bill passed the Senate on Feb. 5 and the House of Representatives passed the bill Feb. 14 with a 75-42 vote, but the Senate was scheduled to discuss it again on Feb. 26.
Gov. says system is broken
Gov. Pat McCrory issued a press release Feb. 12 stating that his first few weeks in office included a review of the advantages and disadvantages of expanding Medicaid and determining the right exchange option for the state.
“The results of our findings make it abundantly clear that North Carolina is not ready to expand the Medicaid system and that we should utilize a federal exchange,” McCrory stated. “In light of recent Medicaid audits, the current system in North Carolina is broken and not ready to expand without great risk to the taxpayers and to the delivery of existing services to those in need. We must first fix and reform the current system.”
He went on to say the ongoing political uncertainty of the federal budget deficit raised concerns regarding the federal government meeting its obligation to provide matching funds under the terms of the Medicaid expansion.
"We are currently working with the General Assembly on technical language revisions to Senate Bill 4 to ensure full and timely funding for NC FAST,” McCrory stated. “This information technology system must be implemented for existing Medicaid services. In addition, this technology also will help reduce fraud and waste.”
Sen. Jim Davis, R-Franklin, voted in favor of blocking the Medicaid expansion.
Rep. Michele D. Presnell, R-Burnsville, also voted in favor of blocking the expansion and said in her weekly newsletter that the Affordable Care Act was still “expensive, inflexible and bureaucratic.”
“As a recent audit of the North Carolina Department of Health and Human Services revealed, our Medicaid system is broken,” she said. “House Republicans understand the need to fix Medicaid as it currently exists before expanding a broken program.”
Democrats oppose the bill
Not one Democrat voted in favor of the bill, and only one republican voted against it. Rep. Joe Sam Queen, D-Waynesville, voted against the measure. He said the Medicaid expansion would have provided health care for more than 500,000 uninsured North Carolinians and would have created 23,000 jobs in the state. He sad the legislation meant a loss of more than 400 jobs in his district of Haywood, Jackson, and Swain counties.
“By rejecting Medicaid expansion, the legislature has cost the taxpayers of North Carolina over $2 billion of their federal tax dollars that would have come to the state and is denying health-care coverage to an estimated 15,000 people in my district,” he said.
North Carolina is not the only state in the country denying Medicaid expansion under President Barack Obama’s Affordable Care Act. Georgia, Kentucky and South Carolina are also considering similar legislation.
“It’s our share of the federal budget,” Queen said. Whether the legislators agree with the president’s health-care reform, “It’s the law of the land – it’s just being denying our citizens,” Queen continued.
“This was a stunning political act with political theater with incredible negative consequences,” Queen said of the General Assembly’s actions. “It doesn’t cost of state anything (to implement the expansion) and it will more than cover our administrative costs.”
He said the federal government would pay for the first three years of expansion and the money could have paid for more health-care providers to provide care. Instead, the blocking of health-care expansion would challenge the state’s rural hospitals because of the lack of revenue and jobs.
“It’s the best health care bill than I can imagine and the best job creator – it doesn’t cost us another nickel to say yes,” Queen said. “We’re certainly going to lose services and providers.”
Hospital supports expansion
Janie Sinacore-Jaberg, new CEO of MedWest–Haywood Hospital, said she thought the Medicaid expansion was important for health-care providers.
“We support the Medicaid expansion, but I truly understand and appreciate where the governor is and the dilemma they have in dealing with the growth,” she said.
Sinacore-Jaberg said she is encouraging hospital associations to work with their states to improve the health-care system. She said MedWest works closely with Community Care of North Carolina to manage its Medicaid population. The CCNC, through a public-private partnership, brings together regional networks of health-care providers to provide cooperative, coordinated care through the Medical Home model. Sinacore-Jaberg said CCNC helps make sure Medicaid and uninsured patients receive proper preventative care.
“We believe health care coverage is critical to the patients in our community. It provides access and gives our patients options instead of visiting the hospital,” said Sinacore-Jaberg. “Not all of our patients are able to pay, but we take them in and make sure they get the care they need. “If there’s a mechanism to reduce our cost, we want to be able to utilize that.”
She added that she wasn’t sure whether the expansion would create the influx of patients or new jobs like has been discussed in Raleigh and nationwide.
“If the volume continued to rise obviously we would need to make sure we have the staff to support that, but it still needs more investigating,” she said. “Just because there’s more (covered) on the expansion doesn’t mean they’re going to seek care automatically. We staff every day based on our patients’ needs.”