Some in GOP open to limited Medicaid expansion

Even though Gov. Roy Cooper’s request to expand North Carolina’s Medicaid program unilaterally has been halted in federal court, some GOP lawmakers say they are open to considering a limited enrollment increase.

“I sense no appetite in the legislature to expand Medicaid per se,” said state Rep. Craig Horn, R-Union, chairman of the Joint Legislative Oversight Program Evaluation Committee. “There is some sense in the legislature that we should look at that portion of Medicaid that deals with the disabled.”

Cooper’s proposed expansion was blocked Saturday by temporary restraining order from U.S. District Court Judge Louise Flanagan. The plan would have expanded Medicaid rolls by between 500,000 and 650,000 people, a majority of them single, able-bodied, working-age males instead of the traditional mix of the poor, children, pregnant and single mothers, the elderly, and disabled.

Horn said “there was some concern” among policymakers and Medicaid advocates whether the current structure allows “some people that were truly in desperate need to slip through the cracks, and not be covered.” Horn said he was willing to consider Cooper’s plan, but that he saw little desire in the General Assembly to undertake a broad expansion of the program.

“I understand both sides of the argument,” said state Rep. Greg Murphy, R-Pitt, a urologic surgeon.

“I’ve been a physician for almost 30 years, and it would be criminal for me to not want everyone to have accessible, affordable, basic health care,” Murphy said. “But as a legislator, I know we have bills to be paid, and we have a fiduciary responsibility to our state.” The state allocated $3.6 billion for Medicaid in 2016.

Murphy supports some provisions in Obamacare, including the one letting children stay on their parents’ health insurance policies until they are 26. “I don’t believe pre-existing conditions should rule people out” from getting coverage, he added.

But he said Cooper showed bad judgment by trying to force expansion immediately after assuming office without consulting the General Assembly, and at a time Congress is voting to repeal the Affordable Care Act, as Obamacare is formally known.

Obamacare, which is the vehicle for Medicaid expansion, “has crippled a lot of the medical industry through its overregulation and burden, and downright, massive bureaucracy, which a lot of the proponents of Obamacare seem to not even think about,” Murphy said. “It’s just a morass of difficult situations, and I think it can be done a lot better.”

The state already has a shortage of physicians, Murphy said, and many don’t accept Medicaid patients, so expanding coverage to more people does not guarantee they will be able to receive care.

From a provider standpoint, “Medicaid is a disaster, and it doesn’t pay the bills, and people take it primarily either because they have to, or they feel a sense of obligation to the community,” Murphy said.

While there is a place for Medicaid in providing a temporary safety net, Murphy said, “the problem is now … we have third-generation families [depending] on Medicaid” who have never had private health insurance.

While Democrats and left-leaning advocacy groups disparage Republicans for not expanding Medicaid under Obamacare, the rolls have been growing.

At an April meeting of the legislature’s joint Medicaid oversight committee, Rep. Nelson Dollar, R-Wake, co-chairman of the committee, said there was a year-over-year enrollment growth of 2.5 percent, or 44,000 additional recipients.

In October 2014, state Sen. Ralph Hise, R-Mitchell, co-chairman of the Senate Appropriations Committee on Health and Human Services, said the state struggled that year to add 120,000 people to Medicaid, and there’s no way the state could add 600,000 new enrollees in a single year financially or administratively.

Dr. C.L. Gray of Hickory, president and founder of Physicians for Reform, which supports patient-centered, free-market changes to health care delivery, has researched Medicaid in depth, and said governors should not expand it.

“There are several studies that show people on Medicaid actually have worse outcomes than people with no insurance at all,” Gray said at an October town hall at High Point University on health care reform. “Higher death rates with surgeries. Higher death rates with various cancers.”

Part of the reason is cultural, “and one big part is just because of the way the system is designed,” Gray said. “It probably has the worst outcome of any system we have in the U.S. Why we would want to expand that system is beyond me. It needs [to be] reformed, not expanded.”

In April, former Gov. Pat McCrory called for limited Medicaid expansion for mental health patients, people with developmental disabilities, and substance abuse patients, among others. McCrory requested a waiver in June from the federal Center for Medicare and Medicaid Services to allow that expansion and begin shifting to a managed-care model for Medicaid, but the waiver has not been granted.