After Supreme Court ruling, no plans to expand Medicaid in NC

Gov. Pat McCrory said Thursday that there are many more questions to be answered before he would move for a Medicaid expansion that would add residents to the government insurance plan.

McCrory has expressed an interest in expanding Medicaid under the Affordable Care Act. But the governor said earlier this year that, until the U.S. Supreme Court case was resolved, it would not make sense to advance a plan.

Answering questions after the Supreme Court ruling on Thursday, McCrory, a Republican, said the issue needs more study and an analysis of data from states that have expanded Medicaid.

“My answer is dependent upon what I think would be best for North Carolina,” he said. “I don’t want a Washington plan for Medicaid; I want a North Carolina plan. It’s a very complex issue. You can’t just say are you for or against it.”

Medicaid expansion would need approval from the legislature, and both House and Senate leaders have said they don’t want it.

Senate leader Phil Berger reiterated those points Thursday afternoon.

“We still have a system of Medicaid in North Carolina that’s broken. I don’t think the Supreme Court’s decision in this case makes any difference in what we need to do,” said Berger, an Eden Republican.

House Speaker Tim Moore indicated as much in a statement as well.

Moore pointed to a bill to overhaul Medicaid that recently passed the House, though it is much different from a version that has cleared the Senate.

“This reform will allow the state to fully fund enrollment growth and eliminate wasteful spending of taxpayer dollars,” said Moore, a Kings Mountain Republican. “Medicaid reform, not expansion, will remain the priority, and today’s court ruling will not directly impact North Carolina’s final decision.”

The state Department of Health and Human Services, which oversees Medicaid, has maintained that the system has improved.

Medicaid expansion is meant to insure low-income adults who make too much to qualify under stricter income guidelines but too little to qualify for subsidized marketplace insurance. An estimated 357,000 to 500,000 North Carolinians fall into the gap. Lisa Turkel of Raleigh is one of them.

Turkel, a former commercial real estate broker, has used Medicaid since 2007. She takes medications for a host of ailments – including osteoporosis and a chronic disease that is destroying the bile ducts in her liver – all contributing to a pharmacy bill that can hit more than $2,300 a month.

Medicaid paid most of those costs, but Turkel was told this week that she no longer qualifies for the government insurance because the Social Security widow’s benefits of $1,200 a month that she started receiving last year pushed her income beyond the upper limit.

She was advised this week at a hearing on her benefits that if she incurs a medical debt of about $5,000, she could then qualify for Medicaid again for six months.

“This is called falling through the cracks,” said Turkel, 57. “As soon as my meds run out, I’m going to have to go check into a hospital just so I can get meds.”

Six states have received permission from the federal government to enact their own “conservative versions” of Medicaid expansion, said Adam Searing, a senior research fellow at the Georgetown University Center for Children and Families.

“While each state is unique in its politics, having a governor be willing to propose a plan is the element required to start the discussion,” said Searing, who supports expansion.

McCrory began talking months ago about possibly expanding Medicaid.

With the state considering “massive Medicaid reform, there’s no reason this couldn’t be part of it,” Searing said. “There are conservative governors who have been politically adept at proposing conservative plans for using Medicaid money. It doesn’t seem like he wants to join them.”

This story was originally published June 26, 2015 at 2:27 PM with the headline "After Supreme Court ruling, no plans to expand Medicaid in NC."