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Dislike Obamacare? Take Medicaid expansion deal anyway

N.C. stands to get about $10 for every state dollar to cover poor

On the same day that N.C. Senate Republicans voted against letting the federal government buy health coverage for a half-million North Carolinians, Ohio’s Republican governor was jumping at the offer.

Ohio Gov. John Kasich, long a Tea Party darling, said he opposes President Obama’s health care reform. But the Affordable Care Act’s Medicaid expansion “makes great sense for the state of Ohio,” Kasich said Monday.

Up to 684,000 uninsured Ohioans would begin receiving health coverage. The federal government would pay 100 percent of the bill for the first three years, then would pull back to 90 percent starting in 2020. Kasich said he wanted to keep the federal government from spending Ohio residents’ federal tax dollars in other states.

Two days later, Michigan Gov. Rick Snyder, also a Republican, announced he supports the Medicaid expansion as well. He said it offers “care for people who need it” – about 450,000 of them in Michigan.

Kasich and Snyder join Arizona Gov. Jan Brewer and three other Republican governors – so far – in backing the Medicaid expansion (along with close to 20 Democratic governors). They let cost-benefit analyses override their general opposition to so-called Obamacare.

It’s time for N.C. Gov. Pat McCrory to conduct the same analysis. Past time, really. By remaining silent on the issue for so long, McCrory has lost some control. While he sits on the sidelines, the legislature rolls ahead with its opposition. Instead of shaping the debate, McCrory’s options are being shaped for him.

In the final moments before the Senate voted, McCrory asked for a delay because he worries the bill could imperil some Medicaid-related IT funding. It might – and it definitely imperils infinitely more in federal funding for the state’s uninsured.

The Supreme Court, when it upheld Obamacare last summer, said the Medicaid expansion had to be optional for the states. The law expands Medicaid to cover most people earning less than 138 percent of the poverty level.

The program is expensive for the federal government, but makes a lot of common sense for North Carolina for a number of reasons:

• About half the states have indicated they’ll join in. States that decline are surrendering their federal tax dollars to those states. North Carolina stands to receive about $2 billion a year from the federal government for the first three years and billions more after that.

• It saves money for the state and for people with insurance. Without Medicaid, patients get less preventive care, leading to bigger health problems later. They seek help in emergency rooms, the most expensive option. That tab, as much as $3 billion a year, is partly paid for by the rest of us through higher insurance premiums.

• It would be a boon for business. The nonprofit N.C. Institute of Medicine estimates the Medicaid expansion would create 25,000 jobs. It would be especially important for rural hospitals, who struggle to make money while providing free indigent care.

• Beyond the dollars and cents, it produces better health outcomes for the 500,000 low-income North Carolinians who would be newly eligible. Those people will be better suited to join or stay in the workforce.

Opponents worry, reasonably, that the feds might not keep their end of the bargain. But the federal government has shown its tendency isn’t to turn off the spending spigot but to keep it on. McCrory could make clear, as Ohio’s Kasich did, that the state could drop the coverage if the feds drop their financial support.

The Senate bill awaits action in the House. McCrory needs to show some leadership, and help House Speaker Thom Tillis throw on the brakes.

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