Good news for the hundreds of thousands of truck drivers, janitors, day-care attendants, fast-food servers and other low-income workers in North Carolina: Gov. Pat McCrory and the legislature may soon reconsider their long-standing opposition to Medicaid expansion.
Aldona Wos, the state Health and Human Services secretary, told the Observer editorial board Wednesday that with some flexibility from the federal government on how things are structured, a half-million or so state residents could become newly eligible for health insurance.
“We really are evaluating the different options and will be presenting them to the governor,” Wos said, echoing what she has told others in recent weeks. “But the road to the end result is a rather long road.”
This marks a dramatic and important turnaround. McCrory, Wos and Republican legislative leaders opposed Medicaid expansion from the first time they considered that provision of the Affordable Care Act. Now they might be open to it, attracting more than $30 billion of federal money in the next eight years to provide health insurance to 300,000 to 500,000 residents – at very little cost to N.C. taxpayers.
McCrory said all along that the state’s Medicaid program was “broken” and so shouldn’t be expanded. He also worried that the federal government wouldn’t live up to its promise to pay 100 percent of the cost for the first three years and 90 percent for years after that.
But Wos recently announced a $63 million budget surplus for the state’s Medicaid program. She told the editorial board that the program is on sound footing and so now expansion is worth considering.
“We obviously have stabilized the department … in a meaningful way,” she said. As for trusting the federal government to hold up its end of the deal, Wos praised other states that have proposed a “clever” solution: Agree to expand Medicaid, but tell the feds the state will quit the minute the federal funding dries up.
Wos and N.C. Medicaid Director Robin Cummings suggested Wednesday that whether North Carolina expands Medicaid will hinge to a great degree on how flexible the federal government is in allowing the state to craft a plan with certain features. They said it’s too early to say precisely what those would be, but said that they would want to incorporate an element of “personal responsibility” on the part of the Medicaid recipient. That could mean rewarding a person for good behavior like losing weight and penalizing her for bad behavior like going to the emergency room for routine care.
North Carolina should have accepted Medicaid expansion long ago rather than make a political statement against Obamacare at the expense of hard-working North Carolinians. It was a good financial deal for the state, and it would have encouraged cheaper preventative care for low-income residents before they encountered more serious problems.
It’s not too late, though. With face-saving measures included or not, Gov. McCrory and legislative leaders can still do the right thing.