Raleigh, N.C. — The liberal MoveOn organization is airing radio commercials in North Carolina placing blame on Gov. Pat McCrory for not expanding access to Medicaid as allowed by the Affordable Care Act.
"On Wednesday, March 19, MoveOn members across the country will be ramping up their national Medicaid expansion campaign by urging GOP leaders to stop blocking health care access for millions of Americans and encouraging them to accept federal funding to expand Medicaid with a series of new TV and radio ads," reads a news release from MoveOn's Civic Action, a 501(c)(4) group.
The release goes on to say, "In North Carolina, MoveOn’s new radio ad will air in Raleigh and criticizes Governor Pat McCrory’s decision to block Medicaid expansion and deny more than 318,000 North Carolinians access to affordable health care coverage. The ad brands the governor’s decision to block hundreds of thousands of his state’s residents from accessing Medicaid as "McCrorycare."
Transcript: The ad is a dialog between an unnamed male character and "Susie." MoveOn McCrory Care Ad
Man: Say Susie, you look under the weather.
Susie: Ehh...I don't feel so good. And I can't afford a doctor. I don't know what I'm going to do.
Man: Well, it's time for some exciting news. You've been automatically enrolled in McCrorycare.
Man: That's right. McCrorycare is Gov. Pat McCrory's special plan for North Carolinians. There's no application, there's no insurance card to carry, and there's NO health care.
Susie: No health care?
Man: No health care. As long as Gov. McCrory refuses the Affordable Care Act's free expansion of Medicaid, 318,000 Tar Heels automatically get no health insurance at all. That's McCrorycare – because Pat McCrory apparently doesn't care.
Susie: Is there a way to un-signup for McCrorycare?
Male: If you'd like McCrorycare to involve actual health care, call the governor's opinion hotline at 919-814-2050 and tell him to support Medicaid expansion now."
Questions: Is it fair and accurate to single McCrory out for holding back Medicaid expansion? Is it really a "free expansion?"
Backup: In order to understand the ad, it is helpful to know that, under the federal Affordable Care Act, what some people call "Obamacare," states have the option of expanding their Medicaid systems to cover individuals and families earning up to 138 percent of the federal poverty level. Currently, the state covers people only up to 100 percent of that threshold.
Because the state did not expand its system, there is a gap between those who are eligible for subsidies for private health insurance under the law – those earning more than 138 percent of the federal poverty level – and those eligible for Medicaid. Those low-income workers have few options to seek affordable health insurance.
MoveOn did not provide formal backup materials with citations for the facts and figures cited in the ad. But a news release announcing the spending linked to an online petition posted by the group.
That petition references "privatizing our existing Medicaid system, and justify not expanding it to cover an additional 500,000 North Carolinians."
That reference is out of date. For much of last year, the McCrory administration had pushed for a plan that would have allowed a select group of managed care companies to handle patients in the state's Medicaid program. That proposal received at chilly reception among lawmakers.
Recently, the administration unveiled a new proposal that would develop "accountable care organizations" to handle patients in the program. The idea behind this proposal, which has also met resistance among lawmakers, is that doctors groups would be paid based on how well they do keeping Medicaid patients healthy.
Still, McCrory did spend much of his first year in office saying that the state's Medicaid system was "broken" and that the state needed to get its house in order before expanding the program.
History: Had this ad aired about a year ago, this ad would have been a candidate for a "red light" under our fact check rating system.
That's because McCrory initially was silent on Medicaid expansion when he took office. Lawmakers, on the other hand, did not wait for McCrory's OK and forged ahead with a bill that would prohibit the state from expanding Medicaid without the General Assembly's approval.
That's still the state of affairs today. McCrory, by himself, is unable to expand Medicaid without the permission of the General Assembly.
However, it's worth noting that McCrory embraced the bill prohibiting expansion before it passed and has stuck with that position ever since.
What McCrory says: WRAL News asked the McCrory administration for both their response to the ad and whether the governor is revising his position now that he has had a year to work with the troubled Medicaid system.
"What the governor has said all along is we've had a problem with Medicaid going over-budget," said Josh Ellis, a spokesman for McCrory. "That was the justification (for not expanding Medicaid) then, and that's the justification now."
Ellis said the administration might take another look at Medicaid expansion once the state's problems are sorted out.
Those problems have been legion, including both a claims processing system and a patient intake system. As well, during the last legislative session, the program unexpectedly ran millions of dollars over budget and could be headed for more cost overruns this year.
With regard to fixing the problems in Medicaid and looking at expansion, Ellis said, "I don't think we're there yet.
One last detail: It's worth noting that the commercial mentions a "free expansion" of Medicaid. That's true, but only for a limited time.
Under the Affordable Care Action, the federal government will pay 100 percent of the costs of expanding Medicaid for three years, starting in 2014. After those three years, the ACA calls for the federal share to drop to 90 percent of the expansion costs.
So, if the ad is describing "free to the state," that's true only for a limited time. And, of course, the expansion costs are being paid by federal taxpayers. However, it's worth noting that federal tax dollars paid from North Carolina residents are going to support expansion in other states.
The call: Leaving the argument over whether expansion would be "free" aside, the general thrust of the commercial is accurate. McCrory has embraced the law that prevents expansion of North Carolina's Medicaid system, and it is unlikely that lawmakers will work to rollback that law without a push from the governor. This ad gets a green light.