McCrory backs bill to stop Medicaid expansion

Posted February 12, 2013

— Gov. Pat McCrory is backing a move by the legislature to block the state from expanding its Medicaid program or participating in the state health insurance exchanges created by the federal Affordable Care Act.

McCrory has held back his thoughts on the issue during his first weeks in office, although he did express concern that the Medicaid portion of the bill could keep North Carolina from drawing down federal funding to improve a key computer system. That concern seems to have taken a less central role in deliberations as the bill has gained momentum in the legislative process.

"Our Medicaid system is broken, and I cannot expand a broken system," McCrory said Tuesday. "It would be unfair to the taxpayers, unfair to the citizens currently receiving Medicaid and unfair to create a new bureaucracy to implement the system."

He cited a recent state audit that found North Carolina has high Medicaid administrative costs because of mismanagement and lax oversight, and he noted that some counties have had problems with a new software program that will handle Medicaid and other social service benefits.

His administration looked at "our existing systems, operations, potential new administrative costs and barriers and the amount of control and flexibility North Carolina will have to reform the system." They concluded that North Carolina's current Medicaid system is in such disarray that it would be hard to build on top of it.

House Speaker Thom Tillis expressed similar thoughts during a morning news conference, saying the bill is "setting the tone" for how North Carolina funds Medicaid in the future.

Gov. Pat McCrory McCrory: Foolish to expand 'broken' Medicaid system

House Speaker Thom Tillis Tillis discusses issues before House

"Before we have a discussion about really increasing the funding to Medicaid, we need to make sure that the process we're putting it into is going to make it more likely that those dollars are going to people who need help versus just being churned through an inefficient and wasteful department," he said.

"This (bill) puts the emphasis back on fixing Medicaid," Tillis added.

Although the federal government promised to pick up the costs for the Medicaid expansion for the first three years and the bulk of costs for several years after that, McCrory said the cost overruns in North Carolina's Medicaid program in recent years make him unsure about putting more people on the rolls.

"I've got to look at the long-term cost, and right now, those costs aren't being clarified by Washington," he said.

McCrory faced a Friday deadline to declare North Carolina's intent on both Medicaid and the health exchange, but the General Assembly took the decision out of his hands to some extent. The Senate has already passed the bill, and  Tillis said his chamber could vote on it as soon as Wednesday.

Partisan politics is also at play. The Affordable Care Act, sometimes called Obamacare, is a key Democratic initiative. McCrory and legislative leaders are Republicans.

The North Carolina Democratic Party quickly criticized McCrory's decision, saying that his appointment of an Affordable Care Act opponent to run the state Medicaid program was a sign he never intended to expand it.

"This is just the latest push by Gov. McCrory to create a smaller government – just small enough fit in between a patient and affordable health care," Democratic Party spokesman Clay Pittman said in a statement.

The Los Angeles Times recently reported that some GOP governors like John Kasich of Ohio and Jan Brewer of Arizona have embraced Medicaid expansion, if not the exchanges.

The North Carolina House passed a bill last session to set up a state health exchange – the online system would allow people who don't have employer-sponsored health coverage to shop for their own insurance – but Tillis said lawmakers and business interests now know more about the costs and benefits of such a system.

"We don't want to confuse the complexities and challenges of national health care by having some of that delegated down to the state and then causing future problems for us," he said.

The previous bill died in the Senate.

Insurance Commissioner Wayne Goodwin said he's disappointed with the legislation, saying his department and the Department and Health and Human Services have already laid the groundwork to implement Affordable Care Act provisions.

"Having a federal exchange in North Carolina will no doubt limit our ability to resolve consumers’ health insurance issues at the state level," Goodwin said in a statement. "People who have questions, concerns or complaints about health insurance will have to seek out help from the federal government rather than from trusted regulators in our own state."

McCrory said he would prefer to have a state-run exchange if the federal government could ensure North Carolina would have the flexibility to handle its own programs, but he said too many issues under the Affordable Care Act remain cloudy.

"This is not an easy decision," he said, noting that he and his advisers have been in office for only five weeks.


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  • ambassadorgray Feb 15, 2013

    Let's see..reduce money going to families in need after their breadwinner is laid off, stop Medicaid expansion, mess with funding for college "Liberal Arts" programs, mess with the ACA for insurance...guess you needed some cost saving measures to justify the raises that you paid to your cabinet. Class warfare..or shall I say classless warfare..at its finest. Oh, and I actually voted for the man, so feel free to blame me. This is not who I thought I was voting for...

  • lexusjones64 Feb 14, 2013

    this things doesn't affect congress or gov. mcCrory.. they are good.. but what about the rest of us

  • DoingMyBest Feb 13, 2013

    Emergency room for basic care is terribly inefficient and costly ,
    The bill is still huge and needs to be paid. The average ER bill is well over a thousand and every time I go, the overall out of pocket cost is more than that. 10,000 dollar bills are not uncommon. - Plenty"

    And the reason you are using the ER instead of a doctor or urgent care is?

  • mountainlover Feb 13, 2013

    Plenty Coups: I will have to pay more all the way around. I am a state employee in another state who planned to retire to NC. The amount in box DD of my W-2 form is over $10,600; therefore, in 2018, I will be deemed to have a "cadillac health care plan" and my health care benefits will be reduced. There is no chance that my state is going to pay a 40% excise tax on those benefits. Forget about the fact that I have worked for over 30 years for less than my skills would be worth in the private sector just because the state promised me health insurance upon retirement. I also will pay a higher federal tax and state tax for the increased medicaid recipients, unless I opt to move to a state with no state tax and either spend the money that is generating my interest income or put it somewhere else. And most on medicaid have little to move, aren't worried about a job, and are very "in the know" regarding what states will expand medicaid.

  • Plenty Coups Feb 13, 2013

    Plenty Coups: "I believe that many who qualify for medicaid will move to a state that is taking the medicaid expansion. If Kentucky would take care of all of your medical needs free of charge and NC would not, wouldn't you move?"

    Not if I was poor and couldn't afford a move or had no prospects of a job, or simply didn't know that a state offered it. As it is, I will have to pay more because of this short sighted partisan decision and you will likely too. Emergency room care is the most expensive and inefficient system out there!

  • Plenty Coups Feb 13, 2013

    "The Supreme Court did not uphold the part requiring states to expand Medicaid."

    Who said that it did? I was responding to the poster who claims that the states should try to "get rid of Obamacare".

  • mountainlover Feb 13, 2013

    Plenty Coups: I believe that many who qualify for medicaid will move to a state that is taking the medicaid expansion. If Kentucky would take care of all of your medical needs free of charge and NC would not, wouldn't you move?

  • commonsense4 Feb 13, 2013

    "Yoda, the death panels exist now and they are corporate bean counters at for-profit insurance companies.

    My family's costs will go down after full implementation of ACA. Don't depend on Rush and Fox to do all your research for you."

    goldenosprey - Unfortunately they would rather believe outrageous lies and jump on the polarization wagon then give it some serious research and find the facts.

  • mountainlover Feb 13, 2013

    "Umm, its the law of the land. Passed by Congress, signed by the President, and upheld by the supreme court."

    The Supreme Court did not uphold the part requiring states to expand Medicaid.

  • commonsense4 Feb 13, 2013

    "McCroy, Art Pope, I don't care just thank God the Perdue, Easley, Black circus has left town."

    Unfortunately we will all see that Art Pope will be much more devastating to this state than any man or woman that came before.