Medicaid expansion, cost control not mutually exclusive, backers say

Posted June 4, 2014

— A coalition of groups on Wednesday continued to pressure North Carolina lawmakers to rethink their decision not to expand Medicaid as allowed under the Affordable Care Act.

The groups rallied outside the Legislative Building, displaying signs that read "Patients Over Politics" and "Stop the Medicaid Blockade," and said worries about Medicaid costs shouldn't preclude opening up the health insurance program to more low-income residents.

On Tuesday, lawmakers learned that the U.S. Department of Health and Human Services had nixed the state's plans to levy $60 million in assessments on local mental health agencies that participate in Medicaid, which has thrown budgeting out of whack for 2014-15.

The Senate budget, which was approved last weekend, already cuts Medicaid to the minimum requirements established by the federal government, ending support or eligibility for about 15,000 disabled or elderly people statewide.

Sen. Angela Bryant, D-Nash, said Medicaid has unfairly become an easy scapegoat for lawmakers dealing with tight budgets in recent years.

"We have to attack this notion of Medicaid as the enemy. Medicaid is being used as an excuse for everything that is happening in our state," Bryant said. "There's no attention to the fact that we have these tax giveaways. ... It's poor people's fault that we can't do whatever it is we can't do in the budget."

House Minority Leader Larry Hall said expanding Medicaid would bring $38 million in federal funds to the state this year and $121 million next year, along with creating thousands of health care jobs.

"By our refusal to expand, we are paying for the help and the health and the jobs to go to other states," said Hall, D-Durham.

Belhaven Mayor Adam O'Neal said rural hospitals, such as the Vidant Pungo Hospital in his eastern North Carolina town, are under financial stress because Medicaid hasn't been expanded.

The hospital came close to closing this year before officials worked out a deal with Greenville-based Vidant Health to keep it open.

O'Neal, a Republican, said he understands lawmakers' fears that the federal government will eventually shift much of the cost of the Medicaid expansion to the states, but he said that should be addressed later and not stop North Carolina from providing more access to Medicaid now.

"We're talking about life and death here," he said. "You can't let hospitals close and people die to prove a point."

Rev. William Barber, president of the state NAACP, said Gov. Pat McCrory's insistence that Medicaid be reformed to rein in costs before any expansion can be considered won't work.

"You can't reform what you've already destroyed," Barber said.

Advocates pointed to Arkansas as a model where Medicaid has been expanded and spending controlled.

"That is a false dichotomy, that somehow you cannot expand without exposing us to undue risks of increased costs," Bryant said.


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  • ohmygosh Jun 4, 2014

    You can add more without cost if:
    For every x% you add to the roles you reduce the benefits x+y%. The adder is to handle the increased overhead. At the end of the year, the program determines if it lost of saved money. The benefits are adjusted again so the program is solvent.
    Any other strategy is a shell game where money is shifted around and nobody knows how much is really being spent.

  • Kenny Dunn Jun 4, 2014
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    It was an immoral idea to levy "assessments" on the mental health providers in the first place. That's where the GA when wrong on this one. I'm glad DHHS straightened it out.

  • Bill Mooney Jun 4, 2014
    user avatar

    This administration is incompetent. Truly incompetent.