Does the N.C. Chamber of Commerce have a position on the Medicaid expansion?

Whether to expand Medicaid or not under the auspices of the Affordable Care Act is one of the biggest decisions facing our General Assembly and Governor this year. The North Carolina chamber of Commerce is oddly silent on this crucial issue (I cannot find mention of it on their website; if I missed it, someone point me to it; they do have a general opposition to the Affordable Care Act). I asked the director of public policy of one of the largest branches of the Chamber and s/he confirmed that they had no position on the Medicaid expansion. South Carolina’s Chamber is similarly non-committal.

In Virginia, the Chamber of Commerce has come out in favor of the expansion:

Simultaneous Medicaid reform and expansion is supported by health care providers, business groups including the Virginia Chamber of Commerce, and patient advocacy groups. Supporters of Medicaid reform and expansion cite the budget savings Virginia will realize as federal funds can be used to cover expenses currently paid by the commonwealth, job creation and better access to coordinated care for patients as reasons to support expansion without delay. (emphasis mine)

Why is the North Carolina Chamber of Commerce silent on the Medicaid expansion? They are big supporters of what the General Assembly has done on Unemployment Insurance (they had a full page add in today’s Raleigh News and Observer thanking those who voted yea) and are a fairly Conservative group that tends to support Republican candidates and causes. However, some of their biggest members are decidedly for the Medicaid expansion. These big time Chamber members have held their fire and been quiet, for now.

In spite of what the General Assembly did this week, I still think the final result goes something like this. Governor McCrory declares victory and announces that his administration has cleaned up the mess they inherited in Medicaid (I think there are both real issues to be fixed/addressed and politically motivated overstatements about both the problems and their making an expansion impossible). The hospitals will agree to essentially self finance all or part of the state’s share to expand Medicaid, which also will provide both political and revenue cover to help make the preferred Republican tax reform proposal add up (shifting as much as possible to sales/consumption taxes and away from income taxes, both corporate and personal). The intangible effect of North Carolina being between Virginia moving ahead, and the deep South saying no to the expansion, will intensify the pressure to move ahead, in what is now a tug of war between ideology and practical problem solving mixed with self interest.

The one thing that could really change the calculus would be for Republicans to identify a coherent strategy to expand health insurance coverage outside of the Medicaid expansion, or to use an expansion for leverage for bigger changes in the program. Do they have any ideas? If they bring them forth, I will seriously consider them on this blog. Here is an example of one I suggested over two years ago.

More on North Carolina’s Medicaid decision here, here, here, here, and here.

update: fixed a typo and Rose Hoban noted on twitter that a N.C. Chamber of Commerce representative confirmed to her that they have no position on Medicaid expansion in North Carolina.

About Don Taylor
Professor of Public Policy at Duke University (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute). I am one of the founding faculty of the Margolis Center for Health Policy, and currently serve as Chair of Duke's University Priorities Committee (UPC). 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

2 Responses to Does the N.C. Chamber of Commerce have a position on the Medicaid expansion?

  1. Pingback: Quick Medicaid hits | freeforall

  2. Pingback: NC hospitals start to revolt against NC Chamber | freeforall

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