In public policy debates it’s common for different organizations to disagree about crunching numbers and examining trends. We often disagree about which states should serve as models for North Carolina. All of that is understandable.
Last week John Hood, president of the John Locke Foundation, decided to change this dynamic in a column distributed by the Insider. In that column, which is mostly about Medicaid, he accuses groups that disagree with him of lying.
Specifically, he says this claim was untrue:
North Carolinians were told that regardless of whether the state set up its own Obamacare exchange or allowed the federal government to do so, state government would have to fund the exchange’s operating costs. This claim was false.
Since I was in the middle of that discussion I can report on what was actually said in both public and private debates.
When the legislature this year pushed a bill to reject Medicaid expansion they included in the legislation a provision that essentially turned over all responsibility for establishing a health benefits exchange in North Carolina to the federal government. A health exchange, as a reminder, is the online marketplace where people can shop for insurance. Some people, depending on income, will qualify for subsidized coverage when purchasing a policy through the exchange.
Some legislators and conservative activists argued that it would be fiscally irresponsible for North Carolina to set up a state exchange. What we pointed out, along with a few others, is that whether we establish a state, federal, or partnership exchange, the financing doesn’t change. The federal government will pay for establishing the exchange and then it must be self-supporting.
That means North Carolinians must pay for the operations of the North Carolina exchange.
As we also pointed out, if the federal government operates our exchange then it will be financed by an insurer user fee, in effect a premium tax, on North Carolina insurance companies and insurance purchasers. If the state set up its own exchange we could both control its size and pull from more diverse funding streams. We may not want to load the entire cost of the exchange on to premiums.
It is clear what Hood is trying to accomplish in his column. He wants to say that groups like us lied to legislators and the public about funding the exchange. We, therefore, can’t be trusted when it comes to Medicaid. That is irresponsible and it is misleading. And the Insider should be more cautious in distributing such attacks.
