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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.

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We wrote a brief, which you can read here, about a Senate budget provision that will throw thousands of pregnant women off of Medicaid. The bill moves Medicaid eligibility for pregnant women from 185 percent of federal poverty level (about $21,000 per year for a single person) to 133 percent of federal poverty level (or about $15,000 per year for a single person).

The Senate also creates a small voucher program to help some of these women purchase private insurance, but the way the provision is written means that very few women, if any, will qualify for full coverage during their entire pregnancy.

Besides violating good sense, it also turns out that this provision violates federal regulation.

The federal rule regarding Medicaid eligibility says that states can’t cut the minimum income for pregnant women to qualify below what the state had authorized by July 1, 1989. This date was chosen because many states expanded Medicaid eligibility for pregnant women in 1988 and 1989.

In its 1989 budget (which became effective on July 1, 1989) the North Carolina legislature authorized Medicaid eligibility for pregnant women to increase to 150 percent of the federal poverty level. Although the increase to 150 percent of federal poverty level did not take effect until 1990, the higher rate was authorized by July 1, 1989.

That means that the North Carolina legislature, even if it is determined to kick pregnant women out of Medicaid, can’t set eligibility below 150 percent of the federal poverty level. This is just one more reason to delay or cancel this ill conceived plan until we understand its impact.

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In 1988 North Carolina had the nation’s highest infant mortality rate. The state decided to tackle this tragedy in a variety of ways. One approach, championed in a bipartisan effort by Republican Governor Jim Martin, was to expand Medicaid coverage to pregnant women earning up to 185 percent of federal poverty level and creating a package of programs within Medicaid to ensure good maternity care and a safe delivery.

Pregnant women who qualify now get excellent care in Medicaid and we have made some progress with our infant mortality rates. The legislature is now set to roll back that progress.

One of the Senate budget provisions moves Medicaid eligibility for pregnant women down from 185 percent of federal poverty level to 133 percent of federal poverty level (about $15,000 in annual income). The rest of the provision is a poorly constructed attempt to provide political cover for this mean spirited move.

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Our friends over at the NC Council of Churches have posted on their blog a conversation between our own Nicole Dozier and Council of Churches Volunteer Program Associate Sandy Irving about the legislature’s decision to block Medicaid expansion.

Here is the third paragraph of the article:

Nicole goes on to note that “the good news is that God is a God of second chances. On this group’s behalf, I am entreating the lawmakers who are blessed with the option of premium-free health coverage but who rejected federal money and blocked my brothers and sisters from having the same, to change their minds and their votes and to use the gift of the Affordable Care Act to expand Medicaid.”  And she further adds that she “wants to sincerely thank the lawmakers who through their testimonies, their actions, and their votes, were upstanders for the 500,000 uninsured working adults who deserve access to care resulting in better outcomes and a stronger North Carolina and who deserve to move forward with the rest of us who will be benefiting from the Affordable Care Act.“

Please read the entire post here. As we have said, rejecting Medicaid makes no moral or economic sense.

 

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I’m not sure who is in charge of Gov. Pat McCrory’s twitter feed but apparently they are impressed with themselves. Here’s a tweet they sent out:

McCrory_A

 

 

 

 

The problem is that the administration did not get an “A” from the Triangle Business Journal. The Governor received an “A” rating from about 340 people who clicked on the online poll hosted on the TBJ website. And McCrory got a C, D, or F from about 511 voters. 41 percent of the voters rated the Governor’s performance as a “D” or “F”. And this is from a rather conservative readership.