Raleigh, N.C. — Four years after the passage of the Affordable Care Act, North Carolina lawmakers are again drawing battle lines over the controversial overhaul of the nation's health care insurance system.
Tuesday was the first meeting of the Joint Study Committee on the Affordable Care Act and Implementation Issues, a special study panel created in January by Republican House Speaker Thom Tillis and Senate President Pro Tem Phil Berger.
“Given the steps we have taken over the last three years to reduce taxes and regulations on working North Carolinians, it’s important to get to the bottom of how 'Obamacare' impacts our state’s economy and citizens on a daily basis," Tillis and Berger said in the press release announcing the panel's formation. "This committee will delve deeply into the problems 'Obamacare' has caused to the health insurance marketplace and to our economy as businesses and individuals absorb the costs.”
Attacks on the Affordable Care Act are expected to be a central theme of the Republican Party's national campaign strategy this fall. They're likely to play out on screens in North Carolina, too, where Tillis is running for the U.S. Senate seat currently held by Democratic Sen. Kay Hagan and Berger's son, Phil Berger Jr., is running for the 6th Congressional District seat being vacated by Republican Congressman Howard Coble.
The first meeting was a series of presentations by experts, beginning with Duke University professor Chris Conover, a conservative health economist and noted critic of President Barack Obama and the Affordable Care Act. Conover is affiliated with the American Enterprise Institute and the Mercatus Center, two conservative think tanks.
Conover, openly dismissive of the law in his two-hour presentation, warned lawmakers that he believes it will be financially disastrous for the state and the country. He predicted it would cost North Carolina's economy the equivalent of 90,000 full-time jobs and may even lead to worse, not better, health outcomes for the very low-income population it was designed to help, because some of the funding for the legislation will come from cuts to Medicaid and Medicare.
The economist also blasted the "confusion" of the law's botched roll-out.
"Chances are only about 50/50 that the ACA, at this point in time, has actually reduced the number of uninsured," he said, a statement supporters of the legislation say is untrue.
Expanding Medicaid, Conover said, could actually hurt the "near poor" – people making between 100 and 138 percent of the federal poverty level – because once they become eligible for Medicaid, they can no longer receive subsidies for private insurance, which he said is superior.
He also warned lawmakers against expanding Medicaid to the "near poor," saying it would be a disincentive to them to work and adding that Medicaid has not been proven to produce enough benefits "to justify its very high costs."
Sen. Ron Rabin, R-Harnett, said that if Conover is even partially right, the result would be an "economic Armageddon" for the state, and lawmakers must prepare for it.
Sen. Floyd McKissick, D-Durham, called the presentation "completely biased."
"Is it intended that we will have someone speak or provide us with information that actually believes the Affordable Care Act is a good idea?" he asked committee co-chairman Rep. Jim Fulghum, R-Wake.
Fulghum responded that he "will welcome recommendations from members" for speakers with other viewpoints.
McKissick said he had not been invited to submit any recommendations but would do so before the next meeting, scheduled for next month in Greensboro.
Meanwhile, Democrats on the panel held their own event Tuesday morning to call attention to people who have benefited from the health care law.
Rep. Beverly Earle, D-Mecklenburg, said the hearing is more about the politics of the law than the policy.
"I think we have a lot of people running for a lot of other elected positions, and that's the only thing that I can think of as to why we are actually taking it on now," Earle said. "I'm not optimistic that we're going to accomplish a lot."
North Carolina is one of the top states for sign-ups through the federal online marketplace. More than 200,000 people have purchased coverage. The deadline for enrolling to avoid a tax penalty this year is March 31.
"The Affordable Care Act is already having a positive impact on the health of the people of North Carolina," said Dr. Susan Eder, a Raleigh psychiatrist and one of several medical professionals who attended the press conference.
Eder said she works with many low-income families previously unable to buy coverage because of pre-existing conditions, from high blood pressure to asthma.
"In a civilized nation, this is a disgrace that is rectified by the Affordable Care Act," Eder said, "and I can tell you all these people that now have gotten private insurance under the ACA are thankful."
Retta Riordan, a small-business owner from Apex, said she had been "uninsurable" before the Affordable Care Act because of a knee injury. She signed up through the federal marketplace last fall and now has coverage.
"To those both in North Carolina and nationally who are advocating the repeal of the Affordable Care Act, I ask you to put yourself in the shoes of those of us who have been uninsured," Riordan said.
Committee member Rep. Verla Insko, D-Orange, said most of the problems with the law's implementation in North Carolina have been caused by Republican leaders' refusal to set up a state exchange or accept federal Medicaid expansion funding.
The law was designed under the assumption that an expansion of Medicaid would help cover low-income people. North Carolina refused the expansion, leaving at least 320,000 low-income people without coverage or subsidy help.
"I think that the main product of these meetings will be talking points for the base for the Republican candidates," Insko said. "Criticizing is the easy thing to do. The hard thing to do is to solve a problem and we're not doing that. That’s what we need to be attending to."