Columns » Jonathan Weiler

N.C. GOP relying on specious claims to get Medicaid bill closer to passage

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The state Legislature appears poised to pass a bill that would block the expansion of Medicaid in North Carolina—a cruel and senseless decision as well as an economically counterproductive one.

"The bill seems to me an attack on poor people, a disregard for their situation," State Rep. Verla Insko, D-Orange, told the House Health and Human Services Committee in opposition to the bill Tuesday.

Senate Bill 4 is scheduled to be discussed in the full House today.

North Carolina could join 10 other states, mostly Republican-led, that have said that they will reject Medicaid expansion, allowed under a Supreme Court decision about Obamacare last summer. Although Gov. McCrory has expressed misgivings about the bill, he publicly supported it on Tuesday.

To justify their position, Republicans have resorted to specious claims, if not outright falsehoods. The most common and insistent argument against Medicaid expansion is that the state can't afford it. But as is typically true when Republicans insist they care about fiscal prudence, the claim is a red herring. Medicaid expansion, which would extend coverage to an estimated half a million North Carolinians who are not currently insured, would cost the state an estimated aggregate outlay of $830 million over the first six years of the program, from 2014–2019.

Washington would kick in the other $15.5 billion during that time, or roughly 95 percent of the total cost. Furthermore, according to the North Carolina Institute of Medicine (NCIOM), North Carolina would actually save about $65 million over the next 10 years, because the state would spend less money to cover the costs of treating the uninsured. The North Carolina Budget and Tax Center estimates larger savings over the first six years of the expansion period.

State Sen. President Pro Tem Phil Berger has insisted that the expansion would cost the state jobs and ultimately hurt North Carolina taxpayers. But according to NCIOM, the program would create about 25,000 new jobs for North Carolinians.

In addition, according to the American Academy of Actuaries, states that reject expansion will have higher health insurance premiums than states that accept it, because the cost of covering the uninsured results in increased premiums for everyone else.

It's long been apparent that Republicans should have no credibility on the question of fiscal prudence. In 2011, North Carolina Republicans rejected the extension of the 1-cent sales tax increase, blowing a billion-dollar hole in the state budget that required brutal cuts to education and other social services. Yet now the North Carolina GOP has the power to ram through tax proposals that will greatly enrich their wealthy friends. Republicans want to massively increase sales taxes and to eliminate state income and corporate taxes.

Even Art Pope, if for obviously self-interested reasons—he owns a chain of discount stores—has expressed deep concern about the regressive nature of such a move. While the proposed change would save rich North Carolinians tens of thousands of dollars a year, it increases the tax burden on as many as 60 percent of Tar Heel residents.

The point is not fiscal probity, but lavishing tax breaks on the rich, sticking middle-class families with the tab and knee-capping government's ability to help the less well off—including by expanding Medicaid.

Three weeks ago, it was widely reported that Florida Gov. Rick Scott, among the highest profile critics of Obamacare, was essentially fabricating data to justify his claim that Florida could not afford Medicaid expansion.

It turns out that Scott was relying on a bogus state study that he'd commissioned. The study estimated the total costs to Florida by ignoring the federal dollars that will pay almost 95 percent of those costs over the first decade. Since Scott continued to insist on the inflated figure—even after critics pointed out that the study he was citing omitted that key fact—it's fair to say that he wasn't especially concerned with telling the truth, let alone Florida's fiscal bottom line.

Medicaid is a flawed program in need of some reforms. But the benefits to the states from expansion clearly and indisputably outweigh the costs, which is why its opponents have resorted to specious arguments or outright falsehoods to justify their opposition.

Falsehoods such as the one GOP Rep. Justin Burr of Albemarle told his fellow lawmakers in committee, "[The federal government] is dangling money in front of our faces as if were free money," he said. "We're dealing with this wet blanket of federal government suffocating our state and suffocating our citizens at every turn."

The real threat posed by Medicaid expansion in North Carolina and elsewhere is not that it's bad for taxpayers, businesses or the state's bottom line. Instead, when government provides services that manifestly improve the lives of ordinary people, and does so affordably, the raison d'etre for the contemporary Republican Party ceases to exist. North Carolina Republicans' opposition to affordably increasing coverage for the uninsured should be viewed in that light.

Legislative reporting by intern Elizabeth Van Brocklin.

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