If only Pat McCrory were right this week when he told a conservative group in Washington that a new federal regulation might force North Carolina to expand its Medicaid program. If that were true, hundreds of thousands more N.C. residents could get medical coverage, and the state could see some economic benefits, too. But the governor, once again, got it wrong on Medicaid.
McCrory made his comments at the Heritage Foundation, where he was honored for conservative reforms. In a question-and-answer session with Heritage Vice President Becky Dunlop, the conversation turned to the federal expansion of Medicaid, which North Carolina declined to participate in earlier this year.
“We just got a new reg which might, in fact, force us to do Medicaid expansion, whether we want to or not, in the upcoming year,” McCrory said.
We’re not sure if McCrory was being alarmist in front of his conservative audience, or if he’s looking for an excuse to reverse his Medicaid decision. But he was incorrect. The regulation he cited involved changes in Medicaid’s “presumptive eligibility” provisions, which previously allowed hospitals to presume that some women, children, the elderly and the disabled would be covered under Medicaid. If the hospital was wrong, it still could bill the state’s Medicaid program for two months.
In July, the U.S. Department of Health and Human Services extended that rule to patients whom hospitals presume would be eligible for expanded Medicaid coverage under Obamacare. That’s the new “reg” McCrory mentioned, but what he left out was that it applies only to states that accepted the Medicaid expansion. So essentially nothing has changed in North Carolina.
What the governor’s comments did do, however, is remind us all who gets hurt by the Medicaid refusal. It’s North Carolinians who were supposed to get the Medicaid coverage available under the expansion, yet aren’t eligible to buy health insurance at the federal exchanges because their incomes are below the poverty line of about $11,000 a year for individuals.
The Affordable Care Act initially provided those people insurance by mandating that all states accept extra federal Medicaid money. The government would pay for 100 percent of the expansion for the first three years, then 90 percent for years after that. But in its ruling affirming the legality of Obamacare last year, the U.S. Supreme Court also said that states could decline the Medicaid money.
North Carolina has, and the decision brings an unintended consequence – it’s bad for business. A Kaiser Foundation study of all 50 states reported this month that states participating in the Medicaid expansion will see double the Medicaid spending growth as states that don’t. That’s more revenue for hospitals and health care businesses – and more jobs in the health care industry.
McCrory didn’t talk about any of that in Washington, preferring instead to fret about a federal bogeyman that didn’t exist. Meanwhile this week, Ohio became the fourth Republican-led state, and 25th overall, to accept the Medicaid expansion. Gov. John Kasich, who pushed for accepting the federal money, is the eighth Republican governor to oversee such an expansion. “It’s just the right thing to do,” he said.
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