It would seem like a no-brainer. The NC Senate passed and the NC House is expected to act shortly on a bill that would reject expanding Medicaid to 500,000 North Carolinians under the Affordable Care Act. If that wasn’t enough, the bill would also reject the establishment of a state-federal partnership health exchange under Obamacare where people can buy health plans with tax credits to make coverage more affordable. When NC was on track to develop a state/federal partnership health exchange the state received $74 million in Affordable Care Act money two months ago to update our computer systems and establish the exchange. The no-Obamacare bill would force NC to return  this money.
Governor Pat McCrory needs this money to update our state health care computer systems. He wrote an ineffectual letter  asking the Senate to delay passage of the no-Obamacare bill becuase of the worry we would have to now pay for all these updates with state money. Now, with the bill in the House, there are statements from the Governor McCrory, House Speaker Tillis , and Senate leader Berger  and others that while they all agree that of course we shouldn’t do Medicaid expansion or a state exchange, they will work on getting the federal money to update our computer systems anyway .
Guys, I have some bad news to break to you. If you reject  the Affordable Care Act health exchange, the very terms of the law that establishes the Affordable Care Act prohibit NC from getting money to implement parts of the Affordable Care Act. This includes updating our state computer systems to work in a state/federal partnership exchange. No state exchange, no federal money for computers to set up one. That’s $40 million out of the state budget – dumb, but pretty simple.