Another day, another political battle in North Carolina.
Last week, Governor Cooper formally moved to expand Medicaid under the Affordable Care Act, which would lead to some five hundred thousand low-income residents gaining access to health care and might, as former Insurance Commissioner Wayne Goodwin told the INDY last year, help tamp down further premium increases on the state's (federally run) health insurance exchange. Next week, after a ten-day public comment period concludes, but just before the Obama administration heads for the exits, the state will submit a request to the Centers for Medicare & Medicaid Services, which will no doubt approve it posthaste.
Viola! Working-class North Carolinians who had previously fallen into the coverage gap—too rich for Medicaid, too poor for Obamacare subsidies—will have health insurance, and most of the cost will be picked up by the federal government.
Of course, this presumes that Obamacare is still a thing six months from now. And it also presumes that Cooper's unilateral action holds up against the inevitable lawsuit.
North Carolina Republicans' antipathy toward Medicaid expansion is well-established. Soon after former governor Pat McCrory took office in 2013, the GOP-run legislature passed a law forbidding the state from running its own health insurance exchange—forcing it to rely on the feds—and prohibiting the governor from expanding Medicaid without the legislature's approval.
But that's just what Cooper did.
It's an aggressive move for a newbie gov who won office by a scant ten thousand votes, and it's already been met by equally aggressive resistance: "Just days into his term as governor," Senate leader Phil Berger scoffed in a statement last week, "Roy Cooper already intends to violate his oath of office with a brazenly illegal attempt to force a massive, budget-busting Obamacare expansion on North Carolina taxpayers."
The "massive, budget-busting" part of Berger's condemnation seems a stretch.
Currently Medicaid covers about 1.8 million residents and costs about $14 billion a year. The feds pick up two-thirds of that tab. Expanding coverage—North Carolina will be the thirty-first state to do so and will follow GOP-led states like Ohio and Indiana—to another half-million people will cost about $6 billion a year; under the ACA, the feds will pay 95 percent of that amount until 2020 and 90 percent afterward. Without the expansion, those federal dollars would go somewhere else.
Which is why Cooper labeled the move "North Carolina common sense." "We can receive between $3 billion and $4 billion to pay for care that hospitals and other providers now give away," his statement read. "That will create jobs, bolster our hospitals, could save some rural hospitals and work toward more stable private insurance premiums."
Also, according to a 2016 report from the N.C. Poverty Research Fund, as many as 1,145 fewer people will die each year because they lack access to health care.
And as much as conservatives harp on the "budget-busting" rhetoric, the data tells a different story: multiple studies have found that Medicaid expansion actually benefits state economies. A 2015 analysis by Deloitte Consulting and the University of Louisville's Urban Studies Institute, for instance, found that Kentucky's Medicaid expansion will add more than forty thousand jobs and inject $30 billion into the state's GDP. A 2014 study from the Cone Health Foundation anticipated similar job gains in North Carolina.
In other words, it will pay for itself.
But the "brazenly illegal" part of Berger's statement merits further examination. The 2013 law states, in plain English, that "the State will not expand the State's Medicaid eligibility under the Medicaid expansion provided in the Affordable Care Act ... unless directed to do so by the General Assembly."
The General Assembly most certainly has not directed him to do so.
Last week, Cooper said the 2013 law "does not apply" to his plan because the law impeded his ability to "look out for the health of the people." Just saying that, however, doesn't make it so.