Editorial: Political 'poison pill' must NOT block Medicaid expansion in N.C.

Tuesday, Aug. 23, 2022 -- The legislature, if its leaders so desired, could today clear the way to expand Medicaid. That's what it should do, no strings attached.

Posted 9:00 a.m. Aug 23, 2022 — Updated 3:22 a.m. Aug 25, 2022

CBC Editorial: Tuesday, Aug. 23, 2022; editorial # 8783

The following is the opinion of Capitol Broadcasting Company

If there’s any finger-pointing to be done for North Carolina’s 13-year failure to expand Medicaid to more than 600,000 North Carolinians – it should be in the direction of the leaders of the North Carolina General Assembly. Anything else is a transparent effort to pass the buck. Senate leader Phil Berger and House Speaker Tim Moore, both Republicans, know it as does Democratic Gov. Roy Cooper.

It is not the reluctance of the state’s hospitals to agreed to changes in the “Certificate of Need” regulations – suddenly injected into the issue -- that has, for the last 13 years, denied insulin to more than 200,000 diabetics or prevented 100,000 women from undergoing annual mammogram screenings. It is the General Assembly’s prohibition against expanding Medicaid and refusal to repeal it.

The legislature, if its leaders so desired, could today clear the way to expand Medicaid. That’s what it should do, no strings attached.

In a recent op-ed, Cooper – a former state legislator familiar with the deal-making maneuvers of the General Assembly -- said it was a legislative tiff over Certificate of Need blocking Medicaid expansion. “North Carolina needs our hospital leaders to step up now and do what’s right for their patients and the health of our state. A negotiated deal by hospitals with the legislature in the next few weeks means we can expand Medicaid, save lives and draw down that desperately needed federal money,” he said. He’s assuming legislative leaders are willing to negotiate – a big assumption.

First, the state House and Senate remain deeply divided on the Medicaid expansion and Certificate of Need issues. That’s where the REAL roadblock exists.

Second, Berger has sought to pin negotiation responsibilities on the hospitals. “As long as the hospitals remain as intransigent as they are, I don’t see that we’re going to make any progress,” he said recently.

But that’s not how the hospitals view it. The N.C. Healthcare Association says it told Berger “elements” of the Senate bill “would be harmful to hospitals and erode the state’s safety net.” House Speaker Tim Moore said he wants to be sure that hospitals agreed to certificate of need changes before his chamber voted on them.

The state’s hospitals, working and promoting Medicaid expansion, have long-agreed to pay an assessment to the state to pay the difference between the 90% federal funding that the 10% cost to the state – as much $600 million annually.

Honesty would have legislative leaders moving to deal with those issues as separate matters. Failing to do so simply continues to treat the health of ALL North Carolinians as a political matter.

Truth is this is a matter of life and death and no political game for at least 4,015 to as many as 14,276 in our state.

That should be the primary concern for our state legislators and governor – not political machinations over health-industry bureaucracy. While not minimizing the significance of those issues concerning the status of “Certificate of Need” regulations, they aren’t nearly as pressing as the need, after 13 years of neglect, to make health care available to hundreds of thousands of citizens who continue to go without.

The reality is that Berger and his fellow legislative leaders have long been reflexively opposed to ANYTHING proposed by former President Barack Obama. They knew including Medicaid Expansion and “Certificate of Need” reform together was a “poison pill” dooming the legislation. There are Democrats and Republicans, who have strong concerns over the impact of “Certificate of Need” reforms on the economic viability of nonprofit and community health care facilities – particularly in rural areas.

There is an important and detailed review and debate to be had over Certificate of Need. But, that has NO relationship to Medicaid expansion. Any discussion of Certificate of Need reform should be full – not short-circuited. Better yet, it should be fully handled as separate legislation outside consideration of Medicaid reform.

Cooper says North Carolina’s been losing $17 million a day in federal Medicaid expansion funds. We’re a bit more conservative. After 13 years, here’s the cost:

BY THE NUMBERS: COSTS OF DENYING HEALTH INSURANCE IN N.C.

2022 (to date) TOTAL 2014-22 Diabetics without medication* 18,254 223,134 Annual mammograms missed* 8,032 104,434 Deaths* 1,240 to 304 14,276 to 4,015 Federal funds lost ** $338 million $17.075 billion Jobs not created ** 8,032 223,134 * Opting Out Of Medicaid Expansion: The Health and Financial Impacts, Health Affairs Blog

** The Economic and Employment Costs of Not Expanding Medicaid in N.C., Center for Health Policy Research, The George Washington University, Dec. 2014

That doesn’t include the number of North Carolinians who’ve been forced to declare bankruptcy where the situation ranks with the worst in the nation, according to an analysis by Urban Institute. Five states have a higher share of residents with medical debt on their credit reports.

Expanding Medicaid in North Carolina is the right thing to do. Plain and simple. It was the right thing to do 14 years ago and it continue to be the righting thing to do now – no excuses, no deals.

The General Assembly comes back into session Tuesday. After 14 years, there’s been plenty of discussion and debate. A clean bill authorizing Medicaid expansion should be offered up, discussed and voted to the governor for a signature.

No excuses, no poison pills, no finger pointing. Act!