NC legislators want Medicaid reform before expansion

RALEIGH – Despite a key win in the Supreme Court and pressure from liberal activists, North Carolina's legislative leaders said this past week that they have no plans to expand the state's Medicaid rolls through President Barack Obama's 2010 health care law.

Demonstrators who have routinely come to the Legislative Building to protest Republican policies arrived again this past week on the coattails of a Supreme Court decision to uphold subsidies for individuals who purchased insurance on federal exchanges. They demanded Republican Gov. Pat McCrory and General Assembly leaders either accept federal funding to expand Medicaid enrollment through the Affordable Care Act, or come up with their own plan to close the insurance gap.

McCrory, who had said he would wait until after the Supreme Court's decision to determine whether to propose expanding Medicaid, said after the June 25 ruling that he'd been in talks with Obama and the Department of Health and Human Services to grant waivers and exceptions for the state to use federal funds to expand the program.

"We're continuing to press our point to not have a Washington plan but to have a North Carolina plan," McCrory said.

But GOP lawmakers in Raleigh have long been averse to the portion of the health care law that allows states to use federal funding to expand Medicaid eligibility. They voted in 2013 to block the state from expanding Medicaid, even as other Republican-led states accepted the federal funding.

Legislative leaders argue that the state's Medicaid structure is inefficient and say reforms are needed before more people can be added to system. Competing proposals in the House and Senate budgets set aside up to $800 million over the next two years to pay for increased enrollment and higher health care costs but offer very different ideas for how to overhaul the system.

Senate Leader Phil Berger, R-Rockingham, said the ruling had not changed how Medicaid is distributed in North Carolina.

"We still have a broken system in North Carolina," Berger said. "We cannot contemplate adding more people to the Medicaid rolls at a time when we are having difficulties sustaining the Medicaid system that we currently have."

Supporters of expansion say another 500,000 North Carolinians could receive coverage if the state allowed adults earning up to 138 percent of the federal poverty line to be eligible for the program.

The federal government would cover 100 percent of the costs of expansion if the state implements it in 2016, after that, the state will gradually have to pay up to 10 percent of the costs. Some Republicans have expressed skepticism whether the federal government will uphold its end of the bargain to cover nearly all the costs of adding new enrollees.

"We're grappling with trying to reform the Medicaid spending that we already have. Creating more expense doesn't seem the prudent course," House Speaker Tim Moore, R-Cleveland said.

The Rev. William Barber, president of the state NAACP, said Republicans were using criticisms of the Medicaid system as a "smokescreen" to avoid making the system more available to the working poor. Adding more people to the system, he said, would create healthcare jobs and pump money into the state economy.

Legislators will have to wait until their return from their holiday break on July 13 to renew their attempts to reach a compromise on Medicaid reform. That break from negotiations between two Republican-led chambers has some Democrats fuming.

"We are going on a summer vacation for all intents and purposes and we still have a major issue that has yet to be resolved," said House Minority Leader Larry Hall, D-Durham, during a press conference on Medicaid.

More than 1.8 million North Carolinians —mostly poor families and the disabled — receive Medicaid. Enrollment has increased 15 percent since the Senate first blocked a move to expand enrollment under the Affordable Care Act.