NC lawmakers vote to bar Medicaid expansion


RALEIGH, N.C. (AP) — North Carolina lawmakers approved a bill Tuesday barring the state from expanding Medicaid under the federal health care overhaul.

Gov. Pat McCrory, a Republican, has indicated he'll sign the GOP-backed bill when it reaches his desk.

The measure approved by the House and Senate makes clear that North Carolina doesn't want to expand Medicaid eligibility and will leave the operation of the state's online health insurance marketplace to the federal government. States have choices on both matters through the federal Affordable Care Act championed by President Barack Obama.

About 500,000 low-income North Carolinians would qualify for government health insurance under the expansion. The federal government said it would cover 100 percent of the state's expansion costs through 2016 and at least 90 percent thereafter.

But several Republican lawmakers said they don't trust Washington to continue paying into the future, predicting more and more of the cost would eventually be shifted to the state.

"This expansion will not help the poor, it will just hasten the day the health care system will collapse," Rep. John Blust (R-Guilford) said.

Democratic lawmakers countered that the state's refusal to expand Medicaid would cost lives and lead to more uninsured people depending on hospital emergency rooms for treatment, driving up health care costs for everyone else.

Sen. Josh Stein (D-Wake) read the expanding list of Republican governors across the country who have decided that Medicaid expansion is in the best financial interests of their states. GOP stalwart Gov. Chris Christie of New Jersey became the latest this week, joining such tea-party backed conservatives as Gov. Jan Brewer of Arizona and Gov. Rick Scott of Florida. Eight Republican governors have agreed to the expansion.

"What you're saying is that the tax dollars paid by North Carolina tax payers will instead go to Arizona, Ohio and New Jersey," Stein chided his Republican colleagues. "By rejecting expansion, you are failing to create thousands of jobs and save lives."

Medicaid currently provides health coverage for more than 1.5 million North Carolina residents — most of them poor children, older adults and the disabled. The program spends about $13 billion in state and federal funds.

A study by a consultant hired by the state Department of Health and Human Services estimated expanding Medicaid would generate 23,000 new jobs in North Carolina through 2021 and increase disposable income by $1 billion a year statewide as doctors and hospitals increased hiring to meet higher demand for compensated treatment.

In addition to lost federal revenue, a review by the legislature's own fiscal research staff released this week said the costs of the state not running its own health care exchange will be higher than lawmakers were originally told. It is now estimated it will cost North Carolina $46 million to develop link its computer systems to the federally-run exchange.

Earlier this month, 73 medical and community groups signed a letter urging McCrory to reconsider their opposition to Medicaid expansion, including AARP North Carolina, the North Carolina Council of Churches, the N.C. Pediatric Society and Duke University Health System.

Sen. Harry Brown, R-Onslow, said that the soaring costs of Medicaid are unsustainable, and that expanding the rolls of those eligible would inevitably lead to cuts in other areas of the state budget, such as education and public safety. If not expanding Medicaid turns out to be a mistake for North Carolina, he said, then the state can simply change course at some point in the future.

"We're being prudent," Brown said of the Republicans. "There's nothing in the bill that says we can't get in the game at a later date."

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