Locke Foundation lashes out

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.


  1. John Hood

    June 19, 2013 at 1:57 pm

    Adam, to say that a claim is false is not necessarily to say that the person making the claim is lying. He or she could be mistaken. I don’t know what you told state lawmakers — and my point contained no reference to you or to the Justice Center. What I was responding to was the fact that state lawmakers had been told by someone that the cost of the exchanges would be a state budget item regardless of whether the state did the exchange or defaulted to the federal exchange. That claim was false. That doesn’t mean it was a lie.

    More generally, I appreciate the tone of your post. I would observe that some of your colleagues routinely accuse me and my colleagues not just of being mistaken but of lying. Policy debates can be spirited, and should be given the stakes, but I agree that we are better off exchanging views on issues, not assassinating personal character.

  2. Adam Linker

    June 19, 2013 at 2:30 pm

    Thanks John. If you were only trying to say that someone told state lawmakers that the exchange would be a budget item I don’t think it would have fit well in your column. You say that “North Carolinians were told …” which suggests that this claim was part of the public debate. I don’t know that many groups that spoke to the press and public about financing the exchange.

    It seems the point of your column is that some groups misled the public about the exchange and they therefore can’t be trusted as we debate Medicaid. But everyone participating in the public conversation that I followed simply explained federal regulations. North Carolinians will finance the operations of the NC exchange.

    I will take you at your word that you meant something very specific — state lawmakers hearing that the exchange would be a budget item — in the column. And I agree that the personal attacks are not helpful.

  3. John Hood

    June 19, 2013 at 2:38 pm

    Adam, the original version of the column had a hyperlink in that paragraph to a CJ Online story that examined a claim in a prior story in the News & Observer. The N&O story is where the original claim was reported — that the state would be paying the feds to run the federal exchange. Oddly, the newspaper didn’t source the claim. Subsequently, the claim was widely repeated among lawmakers and lobbyists. The N&O-reported claim was not that private insurers wishing to participate in the federal exchange would have to pay a surcharge to fund it, a surcharge that presumably would be passed along to the insurers’ exchange customers. Instead, the N&O-reported claim was that state government would be assessed the annual operating cost, a cost to be borne by state taxpayers, which was incorrect then and remains incorrect now.

    Here’s the relevant link: http://www.carolinajournal.com/articles/display_story.html?id=9910

  4. Adam Linker

    June 19, 2013 at 2:47 pm

    So you’re saying we can’t trust the News & Observer.

  5. Louie

    June 19, 2013 at 2:52 pm

    John or Adam,

    Do either of you happen to know where I can get some affordable health insurance? $5000 deductibles suck.

  6. Adam Linker

    June 19, 2013 at 2:57 pm

    Louie, call Health Insurance SmartNC http://www.ncdoi.com/Smart/. They can figure out your options based on your particular circumstances. Otherwise, depending on your situation, you can shop the new health insurance exchange starting October 1 for coverage starting January 1.

  7. Louie

    June 19, 2013 at 4:23 pm

  8. david esmay

    June 19, 2013 at 5:50 pm

    High five to Art.

  9. Doug

    June 19, 2013 at 8:36 pm

    From some of the stories out there recently, you may be out of luck. It looks like a lot of the Obamacare policies are going to be hugely expensive to where the $5000 deductible will look reasonable when you are paying for a high cost plan up front rather than being able to have an affordable monthly payment while taking on the risk of whether or not you will have to visit the doctor. Your best bet may be to go uninsured, pay the fine to the IRS gestapo, hit the ER,then bail on the bill like most of the illegals will continue to be doing.

  10. Susan

    June 19, 2013 at 11:54 pm

    Uhmm…Louie, ACA will not cost you more in health insurance. In case your not aware Doug, the EMTALA, a law passed during the Reagan administration states that all people must not be turned away for ER care if legal or illegal. How many illegals do you see at the ER Doug? Do you work at a hospital?

  11. Doug

    June 20, 2013 at 10:54 am

    Just go out and use your favorite search engine things to find out for yourself what Obamacare is doing for the person becoming insured on individual plans out there (I can’t in good consience recommend google anymore, as you may come up on some list the NSA is targeting). All I have seen recently is that the costs are rising 60% or more in some cases over what a person would pay now. When you take away the low cost option such as a $5,000 deductible plan and add in all kinds of things like abortion and various Cadillac services then by default you will pay more, even with the subsidies.

  12. Doug

    June 20, 2013 at 10:56 am

    Oh and Susan, thanks for making my point….no one is denied ER care so Louie can just follow the scheme I laid out, and pay the tax to the IRS at the end of the year. That will be cheaper than any of the other options you (or I) came up with.

  13. Mary

    June 20, 2013 at 8:12 pm

    I heard on radio today, from someone who is supposed to know, that people can be denied ER care unless in active labor or near the point of death. Others will be sent off to the nearest hospital that will take them. Not likely many will. My own hospital posts a sign to this effect re: maternity in the ER.
    The people who need the insurance the most, the poorest, will most likely not have any at all, according to the expert. Others will be subsidized if they earn about $45,000 a year or less. Their families, I’m not so sure of. Like all big changes, it will take awhile for the kinks to be straightened out. I understand it took some years to get all states into Medicare program. Now they most likely can’t live without it. Give it time, naysayers.

  14. Doug

    June 21, 2013 at 9:39 am

    Your comment is in direct opposition to Susan…who evidently has some healthcare knowledge.

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