In July, Gov. Bev Perdue said she would oppose a federal health care bill that placed additional financial burdens on the states.

“We are all hungry for a solution,” she said, “but the absolute dealbreaker for me as governor is a federal plan that shifts costs to the states.”

Six months later, Congress is finalizing a bill that would do just that by expanding Medicaid — the government health program for the poor. The federal government and the states share the costs of Medicaid, so any new obligation eventually would be borne, at least in part, by state taxpayers. And so far, Perdue has neither opposed the legislation nor stated any strong objections to the financial toll the bills being negotiated in Washington would take on North Carolina residents.

Both the Senate and House versions of the bill would extend Medicaid to between 15 million and 20 million new people. Though congressional leaders and the Obama administration are currently discussing ways to soften some of the blow to state taxpayers, as the bills now stand, the federal government would pick up the tab for newcomers fully for the first five years; after that states are expected to pay their share.

The plan is to expand eligibility to include people living above the federal poverty level. Medicaid now covers adults with incomes at 100 percent of the federal poverty line or below. If Congress expanded coverage to all Americans earning up to 133 percent of the poverty level (Senate version), the number of North Carolinians eligible for Medicaid would increase by 44 percent. Setting the cutoff at 150 percent of the poverty level (House version) would boost eligibility by 66 percent (PDF file).

Either expansion would cost North Carolina hundreds of millions of dollars annually after federal funding drops off. The Social Security Administration places North Carolina’s Medicaid costs for 2010 at $17,261 per patient. Lanier Cansler, the state’s secretary of health and human services, said last week he anticipates an increase in Medicaid enrollment from 1.6 million North Carolinians to 2.4 million should the health care bill become law.

Federal Funds Information for States, a joint project of the National Governors Association and the National Conference of State Legislatures, has projected that, the first three years after additional federal assistance ended, North Carolina’s Medicaid costs would grow by $516 million.

Others governors are crying out against the burden the bill imposes on states.

California Gov. Arnold Schwarzenegger sent a letter last month to House Speaker Nancy Pelosi and other members of the California congressional delegation, urging them to not impose new costs on states through unfunded federal mandates.

Gov. Jim Gibbons of Nevada said in a Jan. 7 press release that his state intends to sue the federal government if the bill becomes law. At least 13 state attorneys general have announced plans to join such a lawsuit.

In a letter to Perdue’s office, state Senate Minority Leader Phil Berger urged the governor to pressure the state’s congressional delegation to “vote for North Carolina and against the Senate bill.” He advised her that it was impossible for the state to “absorb the additional burden without additional revenues.” Berger has not received a response.

Carolina Journal asked the governor’s office what Perdue thought about anticipated increases in Medicaid liabilities. In a response, forwarded by press secretary Chrissy Pearson:

“It has been difficult to know the full potential impact of the reform bill as it is still in motion. Even so, the governor continues to work with the North Carolina Congressional delegation to protect the state’s interests,” she said. “Until there is a bill version we can count on (or count from), the governor will likely remain fairly neutral.”

Sara Burrows is an associate editor of Carolina Journal.