Opinion: Daily Journal

Cooper will lose Medicaid expansion ploy

The General Assembly must approve any plans to expand Medicaid under Obamacare, which may no longer exist even if the governor's plan survives court challenges

Gov. Roy Cooper announced Wednesday he will, by asking Washington to amend the state’s Medicaid plan, expand Medicaid coverage under the Affordable Care Act.

He made the announcement during the 15th Annual Economic Forecast Forum, sponsored by the North Carolina Chamber and the North Carolina Bankers Association.

Cooper’s ploy may draw cheers from the Left, and kudos from hospitals claiming a new source of “free” money, but it will fail. Because it’s illegal.

Senate Bill 4, passed in 2013, says unequivocally, “No department, agency, or institution of this State shall enter into any contracts or commit any resources for the provision of any services related to the federally facilitated Health Benefit Exchange. … No department, agency, or institution of this State shall take any actions not authorized by the General Assembly toward the formation of a State-run Health Benefit Exchange.”

Clear enough?

We had read a rumor, originated through an email by the conservative Carolina Partnership for Reform, that Cooper planned to issue an executive order expanding Medicaid.

We, through our sources, independently confirmed the rumor, although the mechanism Cooper will use is different.

Cooper confirmed the rumor himself Wednesday.

As Sen. Ralph Hise, R-Mitchell, who chairs the Senate committee governing health care policy, told our Dan Way, Cooper can do nothing to expand Medicaid under Obamacare without the General Assembly’s approval. Hise even tried to give the new governor a civics lesson, saying, “I’m quite confident with this decision [Cooper] doesn’t know Medicaid policies, law, or procedures well enough to even attempt in those areas this type of argument.”

The move is on its face unnecessarily confrontational and at its core the metaphorical sharpened sword, a sign of a politically rancorous four years on Jones Street.

So far, 31 states and the District of Columbia have expanded Medicaid, which provides health insurance to low-income, disabled, and some elderly people. Progressive states jumped on the chance to expand the federal health-care program with the theoretical idea of saving money and offering care to millions of uninsured citizens.

But that hasn’t happened.

Lawmakers, meaning members of the General Assembly, are responsible for enacting laws and distributing state money. The coming order also further removes private insurers from the equation and, thus, limits options for patients while severing ties with a free market, which is already hamstrung by Obamacare.
Private insurers have retreated from the North Carolina market — Blue Cross Blue Shield is the lone statewide provider — and premiums and health-care costs, for individuals and business, continue to increase.

Nineteen states, including North Carolina, have decided against expansion, preferring to rely on the market and other provisions of the 2010 Affordable Care Act to take care of their residents.

The federal government — and eventually the states, through taxpayers — fund Medicaid, but the money simply isn’t there and, in turn, expands an already bloated federal deficit.

As Katherine Restrepo, director of health care policy at the John Locke Foundation, wrote in January 2016:

“Medicaid is bankrupting our nation. For every $1 North Carolina spends on its Medicaid program, it triggers almost an additional $2 from the feds. The open-ended match rate strongly incentivizes legislators to push for additional coverage options and extended eligibility since the feds cover a majority of the tab. On the flip side, Medicaid’s flawed funding is just as much of a disincentive for states to scale down on the size of their programs, since a majority of savings accrues back to Washington.

“If North Carolina were to expand Medicaid eligibility for those under 138 percent of the poverty line — $16,000 for an individual — who currently do not qualify for the program — 82 percent are able-bodied, childless adults — the federal government promises to fully fund the cost until 2017. At that point, states will take on some of the financing, maxing out at 10 percent starting in 2020 …

“Starting in 2020, expansion would cost North Carolina $6 billion over the next decade. That comes out to an extra $600 million per year. In the long-term, this will either lead to a reduction in provider payments, diverting resources from other important parts of the budget such as education or transportation, or tax increases.”

In Ohio, as another example, Medicaid expansion under Gov. John Kasich has cost taxpayers $7 billion in a little more than two years, wrote Jason Hart of Watchdog.org in March of last year.

“The federal government — which is $19 trillion in debt — paid $390 million for Ohio Medicaid expansion benefits in February, bringing the program’s total cost since January 2014 to $7.1 billion,” Hart wrote.

Perhaps Cooper hopes to win some sort of constitutional showdown with the General Assembly and eventually prevail in the state Supreme Court which has a 4-3 Democratic majority, thanks to the election of new Associate Justice Mike Morgan.

But even if Cooper wins that lengthy battle, there may be no Obamacare to use as a vehicle for Medicaid expansion.

President-elect Trump has promised to repeal Obamacare, and many Republicans, including House Speaker Paul Ryan of Wisconsin, appear equally committed to ending the ACA as it stands.

Cooper has jumped into the fire, sword in hand. But he’s wrong, and he’s going to lose.