The Daily Tar Heel

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Monday June 27th

State Medicaid expansion not certain

As Gov. Pat McCrory begins his first term, one of his first challenges will be the implementation of the 2010 Affordable Care Act and its mandates on state governments.

The sweeping health care law has two key provisions for states: the creation of an exchange for the state’s health insurance market and the expansion of Medicaid, the federal health care program for the poor.


75 cents
on the dollar paid by Medicaid for state participants

$569 million
Medicaid losses for the state in 2011

$817 million
Medicare losses for the state in 2011

$900 million
paid by N.C. hospitals for charity care in 2011

McCrory and state legislators have yet to make a final decision on the type of exchange the state will adopt, and the question of whether Medicaid will be expanded is still up in the air.

The law requires states to increase Medicaid coverage, with the federal government funding the effort completely until 2017, when states begin to shoulder some of the cost.

But the U.S. Supreme Court’s ruling on the act last summer found that the federal government could not force states to expand Medicaid or threaten to deny them existing federal funding. As a result, numerous Republican governors, including former presidential candidate Rick Perry of Texas, opted out of the expansion.

McCrory has previously said North Carolina would not accept money for the expansion without weighing other options. His office could not be reached for comment.

“We are not privy to anything the Republicans or Gov. McCrory plans,” said N.C. Sen. Ellie Kinnaird, D-Orange, who supports the expansion.

“It’s very important we cover our uninsured people,” she said. “It will only cost more if they are not covered.”

According to the N.C. Hospital Association, state hospitals spent $900 million on charity care in 2011. UNC Hospitals provides charity care programs for individuals with incomes below 250 percent of the federal poverty guidelines.

Even if the state does adopt the expansion, half a million N.C. residents will still be without health insurance, according to the association.

Don Dalton, vice president of public relations for the association, said he is still unsure of how McCrory will act, but he said the expansion will be beneficial for the state.

“People will have better access to care, and people who have access to care will have healthier lives,” he said.

But Mitch Kokai, a political analyst for the right-leaning John Locke Foundation, said the means of paying for the act and its regulations could further depress the state’s economy and hurt businesses.

“You have additional taxes, additional government overreach that should be left to the private sector,” Kokai said. “It is going to have an impact on the ability to grow and expand.”

Kokai said the best way to improve health care is through a market-based approach that would begin to lower health insurance premiums.

“The only way we are ever going to control cost is for patients to determine what ought and what ought not to be funded,” he said.

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