Will North Carolina implement Obamacare?

I am going to do a series of posts looking at the implementation of the Affordable Care Act, aka Obamacare in North Carolina. Surely one of the key goals of the Obama administration’s second term is to see through the implementation of the law in states who have heretofore been opposed. A key question is whether they will be successful in convincing such states to move ahead?

Similarly, a key question for Republican politicians who have been opposed to the law until now is whether they will continue to be opposed, or move ahead with implementation? If they remain opposed, can they provide a better alternative?

Republicans in North Carolina beginning in the Summer of 2010 consistently said they believed Obamacare to be unconstitutional and I take them at their word that they believed this to be true. However, the Supreme Court of the United States disagreed in June, 2012. After that, to the extent that health policy was discussed at all in the recent elections in our state, Republicans said that President Romney would repeal Obamacare on day one, so why move ahead with implementation plans, or even contemplate them? Now that will not occur.

So, what will the new Republican Governor and Republican-controlled General Assembly actually do as they move to govern our state? First, we have some extra time in deciding about whether to set up a state-based insurance exchange in which North Carolinians can purchase private insurance with income based federal subsidies. And even if the federal government initially sets up an exchange which seems likely (that would be similar to the way state based Medicare Advantage plans are offered for sale in N.C.) there will be time to shift to a state based exchange later.

Regarding the potential to expand Medicaid under financially advantageous terms to our state, Republican leaders wisely kept their options open during the campaign and said little about this choice.

As the new Republican majorities in the state move toward governing, it is important to keep in mind the most important question in evaluating any given public policy: what is the counter-factual? Put another way, as compared to what? It is easy to say we don’t want to expand Medicaid, but very hard to figure out a way to provide health insurance to 500,000 North Carolinians in financially advantageous terms.

The process of governing a state tends to be quite practical. The question that should be on the tip of your tongue in considering whether our state will implement Obamacare should be ‘what is the alternative plan to provide health insurance to the 1.3 Million uninsured North Carolinians?’


Coming posts below (if there is a topic you want to see covered, email me and I will try)

Introduction-what is the counter-factual? (this post)

What is a health insurance exchange? (Nov. 15, 2012)

What are the advantages and disadvantages of a state-based exchange?

How many North Carolinians are likely to be covered by a health insurance exchange?

Should N.C. create a state-based exchange or allow the federal government to set up an exchange in our state?

How many persons would be covered by the Obamacare Medicaid expansion?

Are there non-health reasons to expand Medicaid?

How is insurance coverage expansion linked to cost control?

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 https://academiccouncil.duke.edu/ . 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 Will North Carolina implement Obamacare?

  1. Pingback: Will N.C. Implement Obamacare-II What is an Exchange? « freeforall

  2. Pingback: N.C. Gov. Perdue takes a step ahead on exchanges « freeforall

  3. Pingback: Comments on North Carolina setting up an exchange « freeforall

  4. The People of North Carolina ought to say no to Obama Care.I believe that we need to reform our healthcare system.I believe that Obamacare will devastate the economy more.

  5. David Schanzer says:

    Don — What are the comparative advantages/disadvantages of the federal, federal/state, and state-only exchanges?

    • Don Taylor says:

      gonna be writing about that soon. Biggest diff is state run exchanges keep decisions at state level. The fed/state partnerships are not clearly defined (meaning each is likely to be idiosyncratic in terms of functions done by each)

  6. Pingback: North Carolina Republican’s Intro bill to block Medicaid expansion and exchange « freeforall

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