On Tuesday, Feb. 12, Governor McCrory of North Carolina joined a growing chorus of governors who have rejected the proposed state/Fed partnership in running an Insurance “Exchange” and expanded Medicaid portion of the Affordable Care Act (Obamacare.) Many conservatives are eager for more governors to cede Medicaid expansion and implementation entirely to the Obama regime. It would be difficult, at best, for the federal government to implement without state cooperation. They believe it would be impossible without cuts to Medicaid, though initially our President insisted it could be done. Believing “Obamacare” to be a gross expansion and unaffordable overstepping by the Federal government, conservatives are not eager to make that impending debacle any easier. However, our esteemed Governor’s decision is not based on trying to stick it to Obama, tempting as that is at times. Nor is his desire to hurt the poor, contrary to many editorial claims. McCrory cited four main reasons for his decision, based on sound reasoning, not the least of which is the ability to afford the “Affordable Care”:
“1) In light of recent Medicaid audits, the current system in North Carolina is broken and not ready to expand without great risk to the taxpayers and to the delivery of existing services to those in need. We must first fix and reform the current system.
2) The potential long-term cost to the North Carolina taxpayer and needed flexibility for reform cannot be determined based upon the information and details provided to us by the federal government.
3) There has been a lack of preparation within state government during the past year to build necessary and reliable systems to implement a state exchange.
4) Due to the ongoing political uncertainty of the federal budget deficit, there is long-term concern regarding the federal government’s continuing of its obligation for matching funds under the terms of the Medicaid expansion.”
McCrory was concerned that a recent audit found that NC Medicaid administrators used flawed or incomplete budget forecasting methods. As a result, there was $418 million shortfall in funding for Medicaid, contributing to McCrory’s skepticism that the state is in any position to expand coverage.
Interestingly, the State Insurance Commissioner, Wayne Goodwin, a Democrat, supports a state-run exchange on the basis that states know better than the Feds how to best allocate funds and make decisions regarding NC constituents. Ironic to employ that argument now, in the face of the largest federal expansion ever into the health affairs of private citizens, passed by his party.
“Just as I did with their predecessors, I have expressed my concern that the state of North Carolina knows best for North Carolinians than the United States federal government does, particularly as it relates to health insurance and exchange matters. There are a variety of reasons why the others have varying opinions, but I believe that the state should do its job and protect consumers and help regulate this marketplace,” Goodwin told The Insurance Journal.
The Federal Government promises federal money to states who agree to set up the State medicaid expansion, covering any additional costs to the state for the first three years. Supporters argue that as much as 500,000 currently uninsured people would be henceforth covered. States have until Feb. 15 to decide if they want to partner with the Feds in an “insurance exchange.” McCrory hasn’t signed any bill yet, but has clearly indicated that his answer right now is , “No thanks.”
Not surprisingly, McCrory’s opponents argue that the 500,000 poorest citizens of our state would have their healthcare fully funded by the Federal Government until 2017, and to reject this offer is folly. After that time, 10 % of the costs would have to be covered by the State. Proponents claim this is a jobs bill, almost as though they believe the Federal funds will be paid by someone other than taxpayers. They claim the generous provision comes at ” no cost” to the state. Perhaps it would be valuable to pause and conduct a lesson on where the Feds get their money for all these programs, but I will leave that for wiser folk to hash out.
“It would treat our sickest people during those three years at no cost to the state. There is no reason for us not to do this,” said Rep. Verla Insko, D-Orange.
Well, yes there is.
If the Feds can’t meet that obligation, and many analysts feel they cannot, what happens to those 500,000 people? And what makes anyone think a state foundering with a huge budget shortfall currently in Medicaid costs should add more recipients? And just in case the point wasn’t sufficiently hammered home, who is supplying all that money to the Federal Government?
NC Republicans are hesitant to trust Uncle Sam with his increasing waist size and voracious appetite for spending and debt. They are unwilling to accept the promised money will be forthcoming, and what then?
“You’re telling me that we’re going to expand this to 500,000 people, which is the estimate that would be covered, for three years and then we’re just going to throw them off the boat at that time?” asked Rep. Marilyn Avila, R-Wake.
It looks likely that later this week the bill rejecting State involvement in either proposal will pass the house, as it already did the Senate last week. It is also likely that a chorus of outrage will be raised about the Republicans that want to kill poor, old, and sick people. McCrory made a good decision, based on reality. For every benefit there is a cost. The cost cannot be sustained, not by the Feds, not by the State. Ultimately, the money doesn’t materialize out of nowhere- like Mama said, “It doesn’t grow on trees.” Taxpayers in one way or another are the funding source. The devil is in the details…and the details apparently were not quite ironed out in those 3,000 pages of the “Affordable” Care Act. For a party that claims hourly that they are acting “for the children”, it is incomprehensible to me that they consistently expand the government, and increase the debt, borrowing from future generations, without their consent.
By: Vicky Kaseorg
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