CBC Editorial: Friday, June 21, 2019; Editorial #8434

The following is the opinion of Capitol Broadcasting Company

It is cruel and thoughtless to deny health care to North Carolina citizens most in need but least able to get it.

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North Carolina legislative leaders continue to parrot canned talking points from hyper-partisan organizations to justify their opposition to expanding Medicaid. They did it again this week in a letter to Gov. Roy Cooper. These groups, like the legislative leadership, reflexively despise anything initiated by former President Barack Obama – no matter the benefits that might be gained or the hardship their bias inflicts.

A large majority of North Carolina voters support expanding Medicaid. Remember, Medicaid expansion comes at relatively little cost to the state. Thirty-seven states have done it. Federal taxes collected here are paying for expansion in those states.

The leadership’s four points of objection are wrong and misleading. How do we know? We asked Mark Hall who directs the Health Law and Policy Program at the Wake Forest University School of Law. He’s one of the nation's leading scholars in health care law. He’s provided some facts in response to the legislators’ myths.

THE MYTH: “There is no guarantee of continued federal funding, which could put North Carolina taxpayers on the hook for billions of dollars (e.g. N.C. Health Choice).”

THE FACTS: The federal government has never scaled back Medicaid funding before. Even though it could, in theory, cut back funding that's also true for current Medicaid funding. There’s also a simple way to address this concern, as has been done in Arkansas, Arizona, Indiana and Virginia, among others. Include a provision that expansion authorization sunsets if federal funding changes.

THE MYTH: “Medicaid expansion puts able-bodied, working-age adults ahead of those with intellectual and developmental disabilities.”

THE FACTS: Funds for expansion do not divert any current funding for disabled care. Instead, credible research shows that waiting lists for disabled enrollees have grown worse in non-expansion states like North Carolina than in expansion states. Also, in no sense does expansion put anyone "ahead of" people with disabilities. Instead, both groups would now be on par with regard to coverage for essential medical care.

THE MYTH: “Expansion will force the traditional Medicaid population (children, expectant mothers, the elderly) to compete with the able-bodied working-age adults for access to limited doctors.”

THE FACTS: Other states that have expanded Medicaid have not faced major provider capacity problems, in part because expansion provides more funding to hire “physician extenders” such as nurse practitioners.

THE MYTH: “Medicaid expansion will not solve the rural health access crisis because there are already too few doctors to care for people in those communities.”

THE FACTS: While expansion will not solve physician shortages, it will certainly help recruit more providers by substantially increasing funding for rural health care. Additionally, it reduces the burden that rural physicians face of providing uncompensated care for low-income uninsured people. Another way expansion helps rural areas is by helping to keep rural hospitals open. States like North Carolina that have not expanded Medicaid have seen many more rural hospital closures than have expansion states.

The state’s legislative leadership has unilaterally declared as off-the-table, compromise that would include any form of Medicaid expansion. It seems they just want Gov. Roy Cooper to compromise by saying their budget is great.

There are plenty of good reasons for the governor to veto the budget legislative leaders will shove through the General Assembly. But none surpass failure to expand Medicaid.

There’s still time for legislative leaders to reach a reasonable and acceptable compromise with the governor to expand Medicaid.

Sen. Phil Berger, Speaker Tim Moore, show some good faith and some concern for ALL North Carolinians. Agree to expand Medicaid now.