Raleigh, N.C. — The North Carolina Senate moved forward Monday night with a plan to stop Medicaid from expanding under the Affordable Care Act.
The joint federal-state benefit program currently covers low-income parents, children, seniors and people with disabilities, but not low-income adults without children or disabilities. The federal health care reform law is trying to change that by encouraging states to expand their Medicaid programs to cover those adults.
The federal government would pay the entire cost of expanding Medicaid for the first three years and then cover 90 percent of the cost for the following decade.
Republicans leaders say such an expansion is unsustainable.
“People have to understand there is no money tree," said Senate Leader Phil Berger. "It just doesn't appear out of thin air."
He said the agreement would be a job killer that ultimately ends up costing North Carolina taxpayers.
Sen. Pete Brunstetter, R-Forsyth, agreed, adding that Medicaid is an inefficient and broken system.
"The problems we are having with Medicaid are a cancer that is affecting the rest of our budget," he said.
Senate Democrats acknowledged problems with Medicaid, but said the expansion would add medical jobs in North Carolina and help rural hospitals provide better care.
"We should not address (Medicaid's problems) on the back of poor people – people in need of help," said Sen. Malcolm Graham, D-Mecklenburg.
The Senate voted 31-17 Monday on a second reading of Senate Bill 4, which would prevent the expansion in North Carolina.
A group of medical doctors showed up during discussion of the bill Monday to express their opposition.
Daniella Zipkin, associate professor of medicine at Duke University, said poor patients need Medicaid.
"We see how they suffer. We see how they have to decide between going to the grocery store and feeding their family or getting their medication," she said.
The Senate is expected to take up the issue again on Tuesday, which could end in a final vote on the bill.
The North Carolina Justice Center argues that expanding Medicaid would be good for the state.
"It's really a win-win-win situation for people who get coverage, people who would get jobs (and) people buying private coverage," said Adam Searing, director of the justice center's Health Access Coalition.
More than half a million people without insurance in North Carolina wind up in emergency rooms or free clinics to get medical attention, which, experts say, drives up health care costs for everyone else.
“We already spend so much money on health care for those people who are uninsured anyway,” Searing said. “(By expanding Medicaid), the North Carolina Institute of Medicine estimates, we would save $65 million over the next 10 years.”
Gary Greenberg, medical director for the free clinic at Urban Ministries of Wake County, agreed, saying preventive services are cheaper in the long run than emergency care.
“The opportunity it would open, if patients had Medicaid, (would be) to establish continuing care with preventative services, vaccinations and monitoring,” Greenberg said.
Several states are considering expanding their Medicaid programs. The American Academy of Actuaries estimates that premiums will be at least 2 percent higher in states that don’t.