During Tuesday’s televised debate with incumbent Gov. Pat McCrory, Democratic challenger Roy Cooper took several opportunities to chide the governor for refusing both to advocate a North Carolina-based “exchange” that would market policies under the Affordable Care Act and to prod the General Assembly to expand Medicaid coverage under the ACA.
The attorney general may well repeat his Obamacare-related criticisms of McCrory next Tuesday in their final televised debate. After all, Cooper blamed the governor and his legislative allies for “refus[ing] to accept” billions of dollars in tax revenues that were sent to Washington and could have “come back to North Carolina” if Republicans had expanded Medicaid under Obamacare, allowing people with incomes too high to qualify for Medicaid to enroll in the government program.
As noted by Katherine Restrepo, the John Locke Foundation’s health and human services policy analyst, Obamacare expansion would not be free. Even if the federal government agreed to “bring back” some tax dollars, North Carolina taxpayers would have to pick up part of the costs of newly covered Medicaid recipients. These new costs would reduce the state’s budget surplus, cut spending for other programs (including those designed to help low-income residents), or prevent additional tax cuts.
Cooper also said that by failing to develop a state-based Obamacare exchange, Republicans had allowed Blue Cross Blue Shield of North Carolina to become the default provider of health insurance in the individual market, allowing BCBSNC to hike premiums in the absence of a statewide competitor.
This is nonsense. Residents in many states with homegrown exchanges are in worse shape than North Carolinians, making McCrory and the legislative leaders who refused to establish a state exchange not only prescient but also prudent stewards of taxpayers’ money.
Nearly half of the states (23) have established Obamacare exchanges, and more than two-thirds of those exchanges are bankrupt, with the other seven in danger of failing. The bankrupt state-based exchanges received more than $1.7 billion in federal startup loans that never will be repaid. Nearly 1 million Americans who purchased policies on their state’s exchange had to find new plans or go without coverage.
McCrory and conservative legislative leaders did not follow the pack and establish a state exchange — a wise move given the many failures of Obamacare that Cooper refuses to acknowledge.
Not all Democrats have been so kind to President Obama’s signature policy. Former President Bill Clinton last week famously said (before trying to backtrack) that Obamacare was “the craziest thing in the world.” The program might have expanded health insurance coverage, he said, but did so by hiking premiums and deductibles so much that many of the middle-income workers targeted by Obamacare could not afford to sign up for it.
On Wednesday, another Democrat, Minnesota Gov. Mark Dayton, said, “the Affordable Care Act is no longer affordable for increasing numbers of people.” State regulators declared the Gopher State’s individual insurance market in “a state of emergency.” MNsure, the state’s Obamacare exchange, faced the prospect of being an insurance broker with no policies to sell, as all seven insurance companies that operated on the exchange threatened to cut their losses next year and pull out. Six have decided to stay in MNsure for another year, but the largest, Blue Cross Blue Shield of Minnesota, is exiting. And the remaining companies will increase the premiums of their exchange policies from between 50 percent and 67 percent.
We might have lived through similar horror stories if Raleigh had joined the crowd. In 2011, the Republican-led state House passed legislation creating a state-based Obamacare exchange, but the GOP-led Senate did not go along. McCrory’s predecessor, Democrat Bev Perdue, attempted to impose a hybrid federal-state exchange in the final weeks of her administration, but the General Assembly overwhelmingly passed a law in its 2013 session that killed Perdue’s exchange plan and prevented Medicaid expansion without the legislature’s approval.
Raleigh’s Republican leaders made the right call in both instances, and the evidence becomes more overwhelming — especially about the wisdom of not establishing an Obamacare exchange — in nearly every news cycle.
Setting up a North Carolina-based exchange would not have guaranteed lower rates or greater competition. More likely, it would have given a false promise of affordable health care as it squandered tax dollars and eventually left even more North Carolinians scrambling for insurance coverage that was beyond their means.
Rick Henderson (@deregulator) is editor-in-chief of Carolina Journal.