Gov Cooper Plans to Expand Medicaid
January 4, 2017 2 Comments
North Carolina’s Governor Roy Cooper announced today that he will expand Medicaid via an “amendment to the State’s Medicaid program” by this Friday, setting up more conflict between him and the North Carolina General Assembly. Several quick thoughts in what I am sure is just the first step (and not the last one) in this process.
- While running Medicaid is the essence of an Executive Branch State government function (along with education and corrections), the fact that the N.C. General Assembly passed a law in 2013 explicitly not expanding Medicaid sets up another round of conflict between the Governor and the General Assembly over the separation of powers. I have no idea of how that plays out legally.
- Gov Cooper said he was encouraged by “people in Washington” to take this action which presumably means the Obama Administration, who could in theory act quickly on the request. Perhaps it could be undone soon by the Trump Administration, I don’t know.
- The emerging details of the Republican “Repeal and Something…” on the ACA in Washington may have provided some of the impetus for the urgency of this action. It looks increasingly doubtful that a clean repeal will be achieved, and with vague notions from Republican leaders in Washington saying they won’t remove coverage from people or states in any replace plan, this move could redefine the baseline against which a future block grant or increased flexibility in expansion monies could be provided.
- In policy terms, expansion would make North Carolina’s pending 1115 waiver a better policy. Here are some thoughts I have (along with my friend Aaron McKeithan) about the waiver (with me putting on my ‘benefit of the doubt’ hat; maybe Republicans could do the same and we might stumble into a deal?). Here is a past white paper I pitched that makes the point that expansion helps to pave the way for fundamental reform of the Medicaid program and overall health care system in North Carolina. We need a reform that expands insurance coverage while moving away from fee for service in a manner that increases the value we get for the Medicaid dollar spent in our state. Again, the 1115 and expansion go together, they aren’t in opposition in policy terms.
- Gov Cooper calls on the hospitals in the State to pay for expansion since they will benefit greatly in financial terms from expansion. There are a variety of details that can achieve such a self financing, and paying for the expansion is the easiest call ever for the hospitals of the State. For a large health system (like Duke or UNC), the magnitudes might be on the order of “we will give you $50 Million a year in return from $500 Million a year” in increased revenue.
I have a paper coming out in the North Carolina Medical Journal soon that makes the case for Medicaid expansion. The Urban Institute has the best projections/numbers on expansion. I will link up my piece and say more about the financing details when the piece comes out, but it is fairly straightforward to develop an expansion plan in which the total cost to North Carolina is self financed by the hospitals and health systems in the State..