Raleigh, N.C. — North Carolina will reject two central tenets of the federal Affordable Care Act under a bill the House and Senate approved Tuesday.
The House vote was 74-40. The Senate vote was 31-16. Gov. Pat McCrory has said he supports the measure.
The governor and Republican leaders in the House and Senate have remained firm in support of the measure, despite some other GOP administrations around the country embracing Medicaid expansion. New Jersey Gov. Chris Christie is the latest Republican leader to back an expanded Medicaid system in his state.
Changes made during the House-Senate conference committee were "mainly technical," according to those who worked out the compromise. The changes were largely aimed at ensuring the state could continue to draw down federal funding for the NC FAST system, a computer network designed to channel those in need of public aid to the right services. However, advocates point out that North Carolina will be sending back one grant in the hopes of getting another.
Under current law, only those making 100 percent of the federal poverty level are eligible for the health insurance program. Medicaid expansion would have raised the eligibility limit to those making 133 percent of poverty, or about $15,000 for an individual. All of the expansion costs would be carried by the federal government during the initial three years of expansion. The state would then pay 10 percent of the cost after that.
Republicans said they worried that, in subsequent years, the federal government would shift more of that burden to the state.
"The notion that you can solve the federal budget problem... is entirely misguided," Sen. Josh Stein, D-Wake, said during the Senate debate.
But GOP leaders said it wasn't the federal budget they were worried about. Sen. Harry Brown, R-Onslow, said Medicaid threw the budget out of balance last year and was on track to run a $300 million deficit this year.
"We had to go to every other agency in state government to pay for Medicaid," Brown said. "I think we’re just being prudent by taking a step back and seeing how this plays out at the federal level. We can always get back in the game."
In the House, Democrats argued that the state is giving up both the chance to cover more people with health insurance as well as the fringe benefits that would come with the funding.
"We are turning down 23,000 new jobs," said Rep. Joe Sam Queen, D-Haywood.
Debate Tuesday in the House was testy at times.
"Let's stop pretending this is about policy," said Rep. Jean Farmer-Butterfield, D-Wilson. "This is about politics."
That prompted Rep. John Blust, R-Guilford, to push back against the idea that Republicans were acting out of "ill will" or simply to fight a bill championed by a Democratic president.
"It's getting a little tedious to hear this constant cacophony that we're doing things not for good motives but for politics," Blust said, prompting several of his colleagues to stand up to challenge him.
"Is there something we can see that's a concrete plan for the 500,000 people who will not have health insurance?" Rep. Marcus Brandon, D-Guilford, asked Blust.
"No," Blust replied, earning a sharp, "thank you," from Brandon.
Blust went on to say the 500,000 conflated those who are uninsured now with those who would dump their private health coverage in favor publicly funded insurance.
"They (those numbers) are designed to sell something that people wouldn't buy if they could calmly reflect on the facts," Blust said.
Rep. Verla Insko, D-Orange, cited studies from the North Carolina Institute of Medicine to argue that the 500,000 figure was in fact accurate.