The Follies (of McCrory’s maddening meanderings on Medicaid)

The Follies (of McCrory’s maddening meanderings on Medicaid)

- in Fitzsimon File

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Good luck trying to figure out where Governor Pat McCrory actually stands on expanding Medicaid under the Affordable Care Act and providing health care coverage for 500,000 low income adults in North Carolina with the federal government picking up 90 percent of the cost.

It’s almost impossible to understand McCrory’s position and it has been since not long after he was sworn in as governor in January of 2013.

Just a few weeks after McCrory took office the state Senate rushed a bill to the floor that rejected Medicaid expansion and prohibited the state from setting up its own health care exchange to make it easier for people to buy insurance under the health care law.

McCrory sent a letter to every Senator asking them to delay the vote so his administration could explore all the ramifications of the decision, prompting speculation that maybe McCrory, like several other Republican governors, was open to the benefits of Medicaid expansion

Senate leaders ignored the letter and passed the bill the same day and by the time it reached McCrory’s desk he not only signed it, he parroted the right-wing talking point that we can’t trust the federal government.

McCrory it appeared had bought in to the ideological opposition to Medicaid expansion. He also frequently bellowed that Medicaid in North Carolina was broken, and using misleading numbers, unrealistic saving projections and one-time payments owed to the federal government to claim the program’s cost was out of control.

Not only could we not trust the feds, we had to fix our Medicaid system before we could expand it. That seemed to be McCrory’s line for a while, despite constant calls for expansion from hospitals, patient groups and health care advocates.

Then in October of 2013 McCrory made headlines by saying new federal regulations might “force” North Carolina to expand Medicaid, though it wasn’t clear what he was talking about it, telling WITN-TV that “…there’s a lot of unknown regulations and everyone is trying to feel out the consequences of public sector standards and also the private sector is trying to figure out in the long term implications are and I’m going to do a thorough pragmatic review.”

The ideological opposition had become a pragmatic review. That seemed like good news, since any review would surely include studies that showed the significant economic benefits of expansion, the thousands of jobs created and the help for the state’s struggling hospitals, not to mention the half a million people who would receive health care coverage.

That’s where McCrory seemed to linger for the next year or so, somewhere in the pragmatic review stage, though no public review was ever done and he occasionally would fall back on the Medicaid is broken mantra when pressed about expansion.

Then in October of 2014, after several more states including ones with Republican governors had expanded Medicaid, McCrory’s DHHS Secretary Aldona Wos announced that the department was at a place where it could present McCrory “options for Medicaid expansion.”

Later that same month McCrory told a business audience in Raleigh that “I’m also trying to figure out what to do with Medicaid and whether to expand that or not, because the feds are offering all this money, and yet I’ve got to be concerned with the bureaucracy that could be grown because of that.”

That sounded promising. We had moved from pragmatic review to consideration of expansion. Then in January of 2015 McCrory met with President Obama and raised the possibility of getting waivers from Washington to allow North Carolina to develop its own version of Medicaid expansion.

McCrory said he wanted a North Carolina plan, not a Washington plan, which soon became another talking point whenever he was asked about Medicaid.

The Obama Administration had already approved waivers for several state specific plans and has approved more of them since.

Then in February McCrory said in his State of the State speech to the General Assembly that he might bring a “North Carolina plan” forward to expand health care access to the uninsured, though he never used the word Medicaid.

That prompted more speculation that McCrory had a plan or was working on one that he would unveil this legislative session. But not long after his speech McCrory said he would wait until the Supreme Court ruled on the latest challenge to the Affordable Care Act before making any decisions.

The court last month ruled against those challenging the health care subsidies in the ACA, leaving the health care law intact.

McCrory’s latest excuse for delay was no longer valid and he told reporters after the decision that his administration was studying expansion plans in other states and reiterated that he wanted a North Carolina plan.

It sounded like not much had been done, but at least the door was still open. Then in a radio interview last week, he sounded less inclined to support expansion, worried that the state couldn’t come up with its 10 percent share of the cost and saying the state had no received clearance from the federal government for including job requirements in its expansion plan.

McCrory didn’t mention that there is plenty of money to cover the state’s share of expanding the program. Both the House and Senate budgets include hundreds of millions of dollars in tax cuts that could be used instead to create jobs, help hospitals, and provide health care for half a million people.

As to the uncertainty about waivers for McCrory’s plan, that raises questions asked by health care advocates across North Carolina this week, where is McCrory’s plan? Why hasn’t he released it? Why hasn’t he submitted it to Washington for approval?

Does a plan even exist or are McCrory’s latest comments simply the latest round of his confusing and meandering statements about Medicaid since he took office two and a half years ago?

Meanwhile Alaska Governor Bill Walker announced this week that he was expanding Medicaid in his state, bringing the number of states that embraced expansion to 30.

Surely McCrory has studied and vacillated and obfuscated long enough.

Where’s the plan indeed Governor?