It feels a bit like legislative leaders took Gov. McCrory to the edge of a cliff and asked if he would prefer to jump or be pushed off. This morning he decided to jump.
Still, a few points need explanation. McCrory says he opposes an exchange because the state has not done enough work to ready itself. That claim strains credibility.
No one suggested the state would set up a state exchange in 2014. In fact, that’s not possible. What we wanted was to keep a partnership exchange. A partnership exchange is a federal exchange with the state keeping two critical functions. The first thing we would do under a partnership is consumer assistance. We are already doing that and we are a national model. We are more than ready to take on that duty, but now Washington, DC, will run that for us. The second is reviewing our own insurance plans in the exchange. The Department of Insurance has done this for years and is obviously ready to do it in 2014. Again, this goes to Washington.
After running consumer assistance and plan review in 2014 the question is then do we want to take over the exchange in 2015 or have the feds continue to operate it for us.
On Medicaid the question of long-term costs can be addressed in several ways. You could sunset the expansion without penalty once the federal match moves lower than 100 percent and reassess the financial implications to the state at that time. Or, like many states, you could scale back the expansion automatically if the federal matching rate dips below what is promised now.
If you skip out on the first three years of expansion you miss the $124 million in savings to the state and the 25,000 jobs that will be created.
The legislature clearly forced Gov. McCrory’s hand here. But it’s still important to note that the reasons given in his letter to oppose a partnership exchange and the Medicaid expansion are not reasons at all.