Raleigh, N.C. — The state House gave tentative approval Wednesday to legislation blocking the expansion of Medicaid and the development of an online health insurance exchange under the federal Affordable Care Act.
The House voted 75-39 for Senate Bill 4, and a final vote is expected Thursday. After earlier expressing reservations about the bill, Gov. Pat McCrory said Tuesday that the state Medicaid system is too troubled to expand, so he plans to sign the bill into law.
The Medicaid expansion would cover about 500,000 low-income adults in North Carolina, providing them the insurance coverage required when the Affordable Care Act is fully implemented next year. The federal government would pick up the full cost of the expansion for the first three years and the bulk of the costs for several years after that.
"When you get this free money, there's a hook," said Rep. Justin Burr, R-Stanly, predicting federal regulations would eventually cost North Carolina.
"This is one of the problems I have with 'Obamacare' or the Affordable Care Act," said Rep. Nelson Dollar, R-Wake. "There's just a lot of promises that down the road there are no answers for."
Rep. Jeff Collins, R-Franklin, compared the government's offer to pay for expanding Medicaid to "playing with Monopoly money," saying continued spending and borrowing will only aggravate the nation's debt crisis.
"It's coming from your children and grandchildren, if you have any, and it's coming from mine. That's where this money is coming from," Collins said.
Democrats chided Republicans, who last week approved a bill to slash jobless benefits as part of an overhaul of the state unemployment system, for again knocking a safety net out from underneath the poor.
"No one put you in office to say you don’t like something,“ said Marcus Brandon, D-Guilford, who accused Republicans of using demagoguery against the Affordable Care Act. “That’s not governing."
Rep. Deborah Ross, D-Wake, said "fear and loathing" was driving the bill.
"It's fear of something you can't control, and I understand that. But even more than that, it's loathing of the fact that we have the Affordable Care Act in the first place, and that is the saddest thing," Ross said.
Advocates said expanding Medicaid would bring a projected $15 billion into the state’s economy, creating an estimated 25,000 jobs in health care and related sectors by 2016.
"You haven’t created a job in the two years that you’ve been here," an irate Rep. Mickey Michaux, D-Durham, told the GOP majority. "You’ve got 23,000 jobs on the line right here."
Republicans easily defeated three attempts to amend the bill, including a proposal to accept the federal Medicaid expansion funding for the next three years.
"You can't unring that bell," Burr said, noting it would be difficult to withdraw coverage for people once they were on the Medicaid rolls.
Under the bill, North Carolina also would not participate in creating a health exchange, which allows people who don't have employer-sponsored health coverage shop around for their own insurance. Without state support, state residents would have to use a planned federal health exchange.
"This is their idea," Burr said of the federal government. "They should manage it instead of putting it on the state."
The only changes made to the original Senate bill ensure that the state can continue to draw down federal funding for the NC FAST system, a computer system that will channel people to Medicaid and other benefit programs. That amendment means the Senate must agree with the change before the bill is sent to McCrory.