North Carolina Republicans Intro bill to block Medicaid expansion and exchange
January 30, 2013 5 Comments
Update: Thursday, 1/31 11:2am the State Senate Insurance Committee has passed S.B. 4; floor debate Monday night.
Republican Senators Apodaca, Brown and Rucho today introduced Senate Bill 4, whose title is “No N.C. Exchange/No Medicaid Expansion.” The text primarily seems to restate/make clear that the N.C. General Assembly is the only body that can enter into a Partnership Exchange with the federal government (and not the Insurance Commissioner, for example), and also states that only the General Assembly can undertake the Medicaid expansion under the ACA.
My guess is that we will have a federal exchange this year, and the partnership exchange that was put in process under Gov. Perdue will be terminated. I would be very surprised if we don’t do the Medicaid expansion, mostly because of who is for it (Think Duke, UNC, Carolinas Health Care System, Hospital Association), and I suspect it turns out to be a key issue in looming tax reform to be undertaken in a balancing of worries about regressivity in preferred tax reform propoals. Also, most attention on tax reform moves to increase sales taxes are focused on worries about their regressive nature and harming the poor (which are legitimate concerns), but the proposals being discussed would add tremendous sales taxes to health care systems (like Duke, UNC, etc.) in a variety of ways. They are more politically powerful than the poor….
I predict that going ahead with the Medicaid expansion becomes key in allowing the Republicans to get the tax reform they want (overall progressivity/regressivity is influenced by both the tax and spending side). More on all that later
Here is some of my past blogging on the N.C. Medicaid expansion/Exchange set up choice:
- June 28, 2012 (SCOTUS reform decision and federalism)
- June 30,2 012 (outline of N.C. decision and redistributional nature of federal spending)
- July 3, 2012 (more details on N.C. decision)
- August 3, 2012 (Impact of Medicaid expansion on jobs)
- August 13, 2012 (Medicaid is not one program)
- August 21, 2012
- A good overview of evidence on the impact of Medicaid on health from Austin Frakt
Health Exchanges and N.C.
- November 12, 2012 (Will NC implement Obamacare-I?)
- November 15, 2012 (Will NC implement Obamacare-II what is an exchange?)
- November 15, 2012 (Gov Perdue exchange decision)
- November 16, 2012 on N.C. exchange decision (with vid)
Disclosure: I am a professor at Duke but not an employee of Duke Health System, nor do I have any role in the leadership of the health system. My wife is a nurse at UNC hospitals.