The following editorial appeared in the March 2015 print edition of Carolina Journal:
Gov. Pat McCrory is taking heat from mainstream media outlets, liberal advocacy groups, and health care providers because he has refused to sign on to an expansion of Medicaid under the Affordable Care Act, and the promised federal money accompanying that move.
Hang in there, governor. We think your patience will be rewarded.
Much can and possibly will change about the contours of Obamacare over the coming months, making any move now to embrace new regulations and spending commitments for Medicaid — the government health insurance program for the poor, disabled, and children — not only premature but probably unwise.
McCrory has acknowledged as much in recent media interviews. He has noted that the U.S. Supreme Court in early March will hear oral arguments in a lawsuit challenging the legality of providing tax subsidies to Obamacare enrollees who reside in states (including North Carolina) that use the federal exchange to enroll patients. If the justices rule that the subsidies are not permitted (as the law clearly states), Obamacare recipients in North Carolina and roughly three dozen other states would lose their subsidies. The ruling may require an overhaul of Obamacare, including the provisions covering Medicaid.
The court is likely to issue its ruling at the end of June, in the closing days of the General Assembly’s long session and much too late to revamp Medicaid (if it’s needed) this year. The time between legislative sessions will allow policymakers to evaluate the court’s actions and decide the best response. Patience will be rewarded.
The governor also has pointed out that he has little interest in embracing the federal government’s “off the shelf” template for Medicaid expansion, since the provisions are not tailored for the unique circumstances patients, physicians, and medical facilities face in North Carolina. Washington regulators have offered waivers to a few states, allowing some flexibility in how they design Medicaid for the people who can sign up for the program under the new rules, but it’s unclear whether the feds will live up to their promise not to interfere with state-based variations.
Indiana recently agreed to expand Medicaid after conservative Republican Gov. Mike Pence won assurances that the Hoosier State could design its own program with little federal interference. Within a year or so, we’ll have a better idea if Washington has gone along. If so, perhaps North Carolina can establish a Medicaid plan under our control. If not, there’s no reason to surrender more power to the feds. Patience will be rewarded.
Finally, there’s the upcoming presidential election campaign. The 45th president may be a Democrat who sees Obamacare as the logical next step to a single-payer, government-run health care system, or a Republican who sees a mandate to replace all or part of the law with free-market medicine. A decision to expand Medicaid now may seem foolish in hindsight if federal health policy takes a dramatic shift in less than two years.
So stay the course, governor. Your patience should be rewarded.