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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.

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The News & Observer ran a story this weekend about an online petition hosted by Sen. Phil Berger that includes claims about health reform that national health law expert Mark Hall labeled “absurd lies”. WRAL also covered the petition in an online story.

Here is the original petition.

If you’ll notice this petition says:

Please help me stop Obamacare in North Carolina. We already passed a bill in the Senate. Now it’s up to the House and the Governor to protect us from:

Here is the new version.

You’ll notice the change to:

Please help me stop Obamacare in North Carolina. We already passed a bill in the Senate that protects us from:

Apparently Speaker Tillis and the Governor did not like being called out in Berger’s original petition. So, he kindly removed that language while keeping the “absurd lies”. That’s important because outright deception is not that common among politicians. It is true that many elected officials engage in some serious spin. But there is no nugget of truth to the claim that health records will be turned over to the IRS. I don’t think any person who wants to be taken seriously would claim that the form going to the IRS counts as a health record.

Why not just debate health reform on its merits? This sort of misrepresentation doesn’t help anyone.

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Arizona Gov. Jan Brewer became a conservative hero when she was able to get her state to pass one of the harshest immigration laws in the nation. On Monday she gave her State of the State address and spoke in-depth about the Medicaid expansion.

Here is what she said in part:

“By agreeing to expand our Medicaid program just slightly beyond what Arizona voters have twice mandated, we will: Protect rural and safety-net hospitals from being pushed to the brink by their growing costs in caring for the uninsured; Take advantage of the enormous economic benefits – inject 2 Billion dollars into our economy – save and create thousands of jobs; and, Provide health care to hundreds of thousands of low-income Arizonans. Saying ‘no’ to this plan would not save these federal dollars from being spent or direct them to deficit reduction. No, Arizona’s tax dollars would simply be passed to another state – generating jobs and providing health care for citizens in California, Colorado, Nevada, New Mexico or any other expansion state… With this move, we will secure a federal revenue stream to cover the costs of the uninsured who already show up in our doctor’s offices and emergency rooms… Weigh the evidence and do the math. With the realities facing us, taking advantage of this federal assistance is the strategic way to reduce Medicaid pressure on the State budget. We can prevent health care expenses from eroding core services such as education and public safety, and improve Arizona’s ability to compete in the years ahead. I’m committed to doing this, and I want you on my side. Let’s work together in an atmosphere of respect and do what is BEST for Arizona.”

North Carolina’s expansion would be more dramatic than in Arizona, which means it will cover more people, and, instead of bringing in $2 billion we stand to gain more like $15 billion in federal funds. If Medicaid expansion makes sense in Arizona, it makes even more sense in North Carolina.

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North Carolina announced recently that it would pursue a state partnership health benefits exchange. Exchanges, for the uninitiated, are online marketplaces where people can easily compare insurance plans and get premium subsidies to purchase coverage. The exchange will also have in-person assistance for the less computer savvy and maintain a toll free hotline.

Under a state partnership North Carolina will retain some say over how the exchange is run in our state. To help get the exchange started the federal government today granted the state $74 million.

This money will help boost our consumer assistance program and it will help us establish an information technology infrastructure to support the state partnership exchange. This money also means more jobs will be created as we seek to build a better health care system.

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At this morning’s presser Sen. Phil Berger said he did not see his chamber expanding Medicaid or supporting a health benefits exchange in any form.

I’ll address Medicaid first. The Budget and Tax Center has written a brief on why the Medicaid expansion is critical. In that paper they explain that Medicaid would provide health insurance to hundreds of thousands of North Carolinians and bring a flood of federal money in to the state, which would boost job creation and support health care providers. It would help hospitals that see a large percentage of uninsured patients, especially in rural areas of our state.

We would all pay for not implementing the Medicaid expansion. The American Academy of Actuaries says that private insurance premiums will increase faster in states that do not expand Medicaid. That is because there will be more cost shifting in those states with higher uninsured populations. It is also because more folks with more health needs will get subsidies to purchase private insurance if we do not expand Medicaid. That will mean the insurance pool will be filled with people who are not as healthy, which will result in higher premiums.

More businesses with more than 50 employees will pay penalties for not providing health insurance if we do not expand Medicaid. Under health reform, if you own a business with more than 50 employees and you do not offer affordable insurance and at least one of your employees gets federal subsidies to purchase private insurance, then you will be fined. If, however, we expand Medicaid then fewer employees will receive a subsidy, which means fewer businesses will get penalized. There is no fee for a business when employees get Medicaid.

On the exchange it was not surprising to hear Berger say that his caucus is not excited about a state-based exchange. But there is no reason at all to reject a hybrid exchange, or, as it is officially called, a state partnership exchange. Having a partnership exchange means that the federal government pays us to conduct our own consumer assistance program and review insurance plans sold in the exchange. North Carolina is a pioneer in the area of consumer assistance for insurance problems. To turn that function over to the federal government just feels unpatriotic. Maybe I’m just too prideful about North Carolina.

It is also good for North Carolina to review insurance plans sold in our exchange. If insurance companies or consumers have questions about plan approval we know the North Carolina insurance commissioner and we know how to contact him. If I had similar concerns in a federal exchange I would have no clue who to call.

Rejecting a partnership exchange is just saying that we want no say over how things operate in North Carolina. I can understand Berger not wanting to take full ownership of the exchange but rejecting a partnership makes no sense at all.

Every day that North Carolina spends running away from health reform is a day that we get further from where we will need to be one day. Putting off decisions now will only increase our pain in the future. States that embrace reform will get all of the benefits while we get left behind.