A new poll commissioned by NC Child and conducted by PPP polling has me scratching my head. It asked 2,000 North Carolinians if they supported using available funds to close the health insurance gap. 72 percent said yes.
Here’s the actual question:
In North Carolina, more than 350,000 adults, most of them working, cannot afford health insurance on the wages they are paid in industries like retail, construction, and food service. Their incomes are too low to qualify for the tax credits available through the Affordable Care Act and too high to qualify for Medicaid. They are stuck in the “insurance coverage gap.” The Legislature and Governor McCrory could fix the coverage gap by creating a special North Carolina plan in partnership with the Federal government. Do you think North Carolina should make a plan to fix the health insurance coverage gap, or not?
While 72 percent of those polled answered “yes,” 22 percent said “no,” and 6 percent indicated they were not sure.
So should North Carolina make a plan or not? Well, of course North Carolina should make a plan. Even I agree with that.
Here’s what the poll question doesn’t tell you: North Carolina does have a plan. It involves developing a Medicaid system that serves the people of North Carolina — ensuring quality care, budget predictability, and access. The plan also focuses on creating an economic environment that gets people back to work rather than more dependent on government.
NC Child purposely did not ask if poll respondents favored expanding Medicaid because, according to them, that term has become “unnecessarily politicized.” But in press releases and headlines, supporters say the poll shows a majority of North Carolinians favor expanding Medicaid.
Hence the head scratching. When the question is asked accurately and honestly, presenting respondents with all the facts, 68 percent of North Carolinians are not in favor of expanding Medicaid. That’s according to a November 2014 poll from the Foundation for Government Accountability.
Aside from omitting the key word “Medicaid,” here are some facts NCChild left out of the introduction to its poll question:
1. The “partnership with the Federal Government” doesn’t cover the administrative costs associated with Medicaid expansion. In 2013,administrative costs for Medicaid in North Carolina totaled $650 million. Expansion would cost North Carolina taxpayers from day one. Medicaid is currently a $14 billion operation. Expanding that program by hundreds of thousands of new enrollees will cost taxpayers plenty. Whether it’s “federal” dollars or “state” dollars, it all comes from the same source: taxpayers. There are no “free” federal dollars.
2. About 82 percent of the Medicaid expansion population in North Carolina would consist of nondisabled, childless adults of working age. Children up to 18 years old with family incomes up to $4,972 per month already qualify for Medicaid. North Carolina’s Health Choice program and Medicare with a Medicare deductable offer additional health insurance coverage for children. Pregnant women with monthly incomes up to $3,961 are covered under current Medicaid insurance.
3. In North Carolina we have a plan. It calls for re-investing in North Carolina’s economy rather than in more government dependency. Imagine a plan that expanded opportunities and created an environment of economic vitality and job growth. Imagine that people caught in the gap of poor planning and escalating costs created by ObamaCare could instead find a job that enabled them to take care of themselves and their families and purchase heath insurance that best meets their needs. Imagine empowerment rather than entrapment.
4. Health insurance coverage is not the same thing as health care access. One out of four doctors do not accept new Medicaid patients, citing excessive red tape, paperwork, and low reimbursements. Certificate-of-need laws further prohibit access, stifling growth of necessary treatment facilities. Expanding Medicaid does not ensure care.
5. North Carolina’s broken Medicaid system is in the process of being reformed, but it’s not fixed yet. Now we must submit waivers to the federal government, then process and phase in the reforms. It will take about seven years for all necessary changes to take place. The best plan is to see how this works, tweak as necessary, and assess and re-assess throughout the process to ensure Medicaid patients are receiving quality care, taxpayer money is well-spent, and the system is running smoothly.
I’m all for making a plan. But let’s make one that works. Condemning hundreds of thousands of North Carolinians to an expensive health insurance coverage system that doesn’t work is not the answer.
Medicaid expansion is a bad idea. North Carolinians know that. No matter how you couch the question.
Becki Gray (@beckigray) is Vice President for Outreach at the John Locke Foundation.