White House, N.C. Democrats press state to expand Medicaid


McClatchy Washington Bureau

The White House enlisted two top North Carolina Democrats on Monday to urge Gov. Pat McCrory and the legislature to reconsider their opposition to Medicaid expansion under Obamacare.

“Medicaid expansion is a smart choice for states,” White House Spokesman Josh Earnest said during a telephone news conference along with Durham Democrats, Mayor Bill Bell and state Sen. Floyd McKissick.

Earnest said that states would save money “over and above the expense of expanding Medicaid.”

Bell said that in Durham, the state’s fourth largest city, 61,000 people would get insurance if the expansion went through.

“Our residents are really missing out on an opportunity here,” he said, adding that many would be able to purchase coverage for less than $100 a month with Medicaid.

McKissick said the state was turning down $2 billion a year in federal funds, which he estimated would generate 20,000 jobs in the first two years of expansion.

Under the Affordable Care Act, states can expand Medicaid, a federal-state health insurance program for the poor. But to date, North Carolina and 23 other states have declined to do so. Under the expansion, the federal government would pay 100 percent of the costs for the first three years, starting in 2014, then 90 percent, leaving 10 percent to the states.

Earnest said it was a “lost opportunity cost” if states let some of the 100 percent coverage years slip away.

“They can either score short-term political points by attacking the Affordable Care Act and blocking Medicaid, or they can save taxpayer dollars and ensure that thousands of their citizens have access to quality health care,” he said.

He cited a Kaiser Family Foundation study that said that 377,000 North Carolina residents could get insurance in a Medicaid expansion by 2016. North Carolina has an estimated 1.5 million uninsured people.

The North Carolina legislature voted earlier this year to reject Medicaid expansion under the health care law and McCrory Spokesman Kim Genardo said the governor, a Republican, had no plans to revisit that position by calling a special session of the legislature to consider an expansion. The McCrory administration plans to propose its own reforms to the state’s Medicaid system in the spring.

McCrory also has said he did not know how much the 10 percent state share of Medicaid expansion would amount to and didn’t want to agree to pay an unknown cost.

Medicaid makes up 15 percent of the state’s $20 billion budget. The federal government pays about two-thirds of the cost for current participants. It paid about $11 billion and the state paid $3 billion in 2012.

The expansion would cover people who earn up to 133 percent of the federal poverty rate, or about $32,000 for a family of four.

Bell said on the Medicaid call that by not participating in the expansion, North Carolina was paying federal taxes used to expand coverage, but not getting the benefit of it. McKissick said many rural hospitals would face a large burden of caring for people who can’t pay for their health care.

One option for the state would be to follow the example of Arkansas. An alternative plan there calls for the use of federal funds to cover costs through the private insurance exchange system created under the health insurance law instead of expanding Medicaid.

Earnest said the Obama administration has shown it was willing to “work with states to tailor solutions that work for these states,” as was done in Arkansas. “That offer is certainly open to the state of North Carolina,” he said.

McKissick said he was not aware of a discussion of such a plan in North Carolina.

Email: rschoof@mcclatchydc.com; Twitter: @reneeschoof

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