More on North Carolina’s Medicaid Choice

The Budget and Tax Center has put out a fact sheet summarizing North Carolina’s looming decision regarding expanding Medicaid under Obamacare. My previous writing on this focused on the relative size of the outlays of the state and federal government to pay for the coverage expansion (here, and here), but the BTC piece usefully looks at savings in uncompensated care costs that would accrue to North Carolina by expanding Medicaid. A key aspect of their findings for the period 2014-19:

  • 488,867 more persons will be covered by Medicaid in 2014, 95% of whom would otherwise be uninsured
  • The state will have to pay $830 Million for these newly insured persons
  • The costs of uncompensated medical care that are now borne by North Carolina will decrease by $1-$2 Billion, more than offsetting the additional outlays for the Medicaid expansion

So, the state will reduce its costs while adding nearly half a million people to the ranks of the insured. Pretty easy call.

I don’t think I have heard anyone running for office (Governor and all seats in the State legislature are up for election this year) in North Carolina even mention this decision. As I say, I think that it is an easy call to move ahead on the expansion under these terms, and I assume that the hospital/health care systems have made it clear to both parties that they think so as well, leading politicians who generally wouldn’t favor Medicaid expansions to quietly do so under the terms of this deal.

Update: The Budget and Tax Center document also lays out their estimate of the federal cost if N.C. undertakes the full expansion at around $15 Billion over the period 2014-19…..I had been saying I thought it would be ~$20 Billion but that was based on a back of the envelope (at best) calculation on my part.

About Don Taylor
Professor of Public Policy (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute), and Chair of the Academic Council at Duke University . I am one of the founding faculty of the Margolis Center for Health Policy. My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

8 Responses to More on North Carolina’s Medicaid Choice

  1. Hi Don, thanks for writing about the report. Many of the national estimates (Urban Institute and Kaiser) on federal funding coming in to North Carolina via the expansion over the 6-year 2014-2019 window are in the $19-$20 billion range, but the state Division of Medical Assistance currently has the number at $15 billion or more. I’m told that estimate may drift upwards, but for now even the most conservative numbers still make this policy a no-brainer, for sure.

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