Lawmakers forge ahead to block Medicaid expansion

Posted February 4, 2013

— 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.


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  • 68_dodge_polara Feb 5, 2013

    "68 whatever - good one! I get it - you said "unaffordable", rather than "affordable"! But, oh, you're wrong. It's great that you can find humor in the balance of children getting medical care or not though"

    Again, children already had coverage. Can't you read? It's in the article.

  • rroadrunner99 Feb 5, 2013

    Wait until they lose the federal funding, then all of a sudden it becomes a federal requirement to get other federal fund's , then they will be looking to blame somebody else for their big blunder.

  • Terkel Feb 5, 2013

    "The uninsured is not our responsibility. mgnobles

    ummm...so you expect doctors, nurses pharmacists et al. to work for free?" sixnite

    This brings up a good point. No one is forcing anyone to enter the medical field. Be aware that with the advent of 0bamacare you may or may not be paid. I'm sure that will only add to the attraction of a medical career. Maybe we can outsource that too.

  • aetius476 Feb 5, 2013

    "because if they had expanded it 100% of the cost would come from the federal government, and even after 5 years 90% of it would." - junkmail5

    You know full well that this funding stream could change at any time. When future administrations are groaning under the increased debt load, and the full costs of Obamacare, the amount funded by the Feds could change drastically.

    This is my opposition, if we accept the "pot of gold" now, what happens 5-6-7 years from now when the 90% becomes 50% or less? NC is left with an entrenched, massively expanded, free healthcare program to fund on the back of the taxpayer.

    Similar to the stimulus expansion of hiring teachers, great deal for a few years, but then it becomes our burden locally after the federal money dries up.

    And it WILL dry up....

  • bill0 Feb 5, 2013

    "bobbatchelor::::I thought the Affordable Care Act was going to take care of everybody without increased cost to anybody. WHAT HAPPENED?"

    This ignorant nonsense gets posted a ton. Nobody said that. The whole point of an individual mandate is for currently uninsured people to pay for their insurance. There are subsidies for lower income earners, but those will be replacing the subsidies we currently pay directly to hospitals for "uninsured care."

    Frankly, it is was a good idea when republicans proposed it and it is a good idea now that democrats support it.

  • junkmail5 Feb 5, 2013

    By refusing to expand Medicaid by 35%, and making the middle class taxpayer pay for it? How is this "hating" the middle class? - aetius476

    because if they had expanded it 100% of the cost would come from the federal government, and even after 5 years 90% of it would.

    Versus now, where the NC taxpayers get to pay the same taxes to subsidize the Obamacare elements the poor in NC won't get, but also get to pick up 100% of the cost of the uninsured running to the ER and not paying the bill everytime they get a cold because they still don't have insurance under medicaid like they otherwise could have.

    How many middle class folks are on Medicaid? Why should the working people of the state be burdened with providing more free handouts.- aetius476

    Careful now... there's quite a lot of "working people" who would qualify for medicaid under the new law if NC allowed it.

  • ABCNEWS Feb 5, 2013

    Have a HEART folks HAVE A HEART...

  • aetius476 Feb 5, 2013

    "The GOP HATES having a middle class. They only want an Upper Class and all others to be at the bottom. This is nothing new. They are showing it more now that they have complete control." - European American

    By refusing to expand Medicaid by 35%, and making the middle class taxpayer pay for it? How is this "hating" the middle class?

    How many middle class folks are on Medicaid? Why should the working people of the state be burdened with providing more free handouts.

    And, we WILL be burdened when, inevitably, the Feds run out of borrowed money to carry their 90% of this fraud ridden scam.

  • issymayake Feb 5, 2013

    Why you are voting against expanding Medicaid in North Carolina please include a bill the prohibits hospitals from adding the care of the uninsuraed to the bills of the insured causing us to have to pay more not only for medical treatment but for insurance. It is not fair that hospitals are allowed to add $1000's to the bills of the insured to recoup their losses for caring for the uninsured. The uninsured is not our responsibility.

    I could roll with this bill. But we all know that the health care provider lobby would kill it.

  • thinlady1 Feb 5, 2013

    correct me if i'm wrong but didn't our medicaid taxes just go up and what part of that will go to other states if the GOP fights this expansion...why is it when problems within this state are addressed and the big fix is on the way it always seem to be on the backs of the poor and middle class....enough!!!!! please go to the polls and vote these people out of office they don't began to care about anybody but themselves.......