Pat McCrory 4This week state executives from around the country trooped to the White House to discuss a variety of topics with the President including expanding Medicaid under the Affordable Care Act.  Two GOP Governors – our own Pat McCrory and Utah’s Gary Herbert – had very different takes on what was said about Medicaid expansion.  I’ve added the emphasis in the quotes below, but what is clear to me is McCrory simply ignored what the President said and the plain facts on the ground regarding Medicaid expansion.

First, McCrory:

 “Regardless of how you feel about the policy, the dilemma is the execution is being put on the states with absolutely no flexibility to the 50 states’ unique needs,” he said…He said that some states were receiving Medicaid waivers, allowing them to devise their own plans, but that there was too much red tape to get them.

Then Utah’s Governor Herbert:

 Gov. Gary Herbert said Monday he was encouraged after hearing President Barack Obama pledge to work with states on Medicaid expansion during a meeting with the nation’s governors in the White House….. “None of us like just being dictated to by Washington, D.C.,” the governor said in a telephone interview on his way to the airport. “So I’m encouraged by the rhetoric. Let’s hope the actions prove to be commensurate with what the tone and talk was today.”

And here’s what the President actually said:

 The president promised his administration would work with governors to tailor Medicaid expansion programs in his remarks to members of the National Governors Association earlier Monday, according to a transcript released by the White House.

“States that don’t expand Medicaid are going to be leaving up to 5.4 million Americans uninsured. And that doesn’t have to happen. Work with us to get this done. We can provide a lot of flexibility,” Obama said.

States like Arkansas have shown the enormous flexibility the Obama Administration is willing to give states that decide to expand Medicaid.  Arkansas is expanding Medicaid 100% through private health insurance plans!  To pretend that flexibility from the federal government on Medicaid expansion is not available and extensive given examples like this flies in the face of reality.  The simple truth is that conservative governors like Herbert who want to tailor a Medicaid expansion to their state will very likely be able to do so while conservative governors like McCrory will simply look even more ideological in their opposition to expanding health care for the poorest citizens in their state.

Pat McCrory 4You would think the Governor would be smarter than to keep blaming Medicaid for his budget problems every time he gets asked about why he isn’t giving all teachers a much-needed raise.  After all, this is the Governor whose Department of Health and Human Services has done its best to run our Medicaid program into the ground over the last year with actions like failing to pay hospitals and doctors and giving mysterious $37,000 “severance” packages (a higher amount than McCrory’s proposal for first-year teacher’s annual salaries) to political cronies who who work at DHHS for one month.  See a full list here of McCrory’s year of missteps on DHHS and Medicaid.

At what point is the Governor embarrassed with this line?  In today’s version he blames the Affordable Care Act for adding people to NC Medicaid.  Sorry, Governor.  Those people were already eligible in NC for Medicaid.  We didn’t expand coverage in NC to anyone – these are just people that were already eligible for coverage who are now, thanks to the Affordable Care Act, actually finding out that they could get help with health care, unlike the hundreds of thousands you told won’t be getting Medicaid coverage.

Governor, the problem with finding money for teacher salaries isn’t with the Medicaid program you are so busy breaking.  What is?  That half a billion dollars in tax cuts aimed largely at the wealthy in our state you signed into law last year.  It may be easier for you to blame low-income people who need Medicaid for your problems, but look to put your own house in order before you pull out your tired, old and increasingly discredited arguments about Medicaid yet again.

Burr2Senator Richard Burr recently took to WRAL to tout his new supposed “replacement” for the Affordable Care Act.  Others have detailed the many flaws in Burr’s plan – like throwing the three million people already enrolled in private health plans under the ACA off their insurance and block granting our Medicaid programs –  but I have a more fundamental question:  Where is the outrage about the employer taxes in Burr’s plan on  health plans offered to employees?  Yes, that’s right, new taxes.  In the Affordable Care Act, these new taxes were confined to “Cadillac plans” with  generous health benefits and are seen as a primary way to reduce health care costs, but the Act still got raked over the coals by right wing opponents:  ”Obamacare ‘Cadillac Tax’ Causing Large Companies to Slash Health Benefits” screamed a typical headline last year.

What employer plans will Burr tax?  Not just Cadillac plans.  Burr himself  says “very few” plans – but that’s not what the bill says.  Even friendly conservative commentators promoting Burr’s plan talk about over $1 billion in new employer taxes.   The bottom line is that Burr’s plan has at the very least exactly the same – or, by friendly estimates – even more of a tax on employer health plans than the Affordable Care Act.

So, where’s the conservative outrage on Burr’s new employer taxes?  Where are the screaming headlines, the 24/7 Fox coverage of the horrors of the new taxes Burr wants to institute on businesses?  Nowhere to be seen.

Get beyond the usual double standard the conservative media apply in situations like this and you see what Burr’s plan for the vacuous political grandstanding it really is.  But this political grandstanding comes with major new employer taxes – a big downside for any politician who hopes to use Burr’s plan as their “alternative” to the Affordable Care Act.


Join the NC Justice Center’s Health Access Coalition in Marion for an educational forum and community conversation on the Affordable Care Act, the online marketplace and the Medicaid expansion.

Adam Linker, Nicole Dozier and I will be there to discuss the benefits of the Affordable Care Act, how Medicaid expansion would help the community, and the new online marketplace, including eligibility for tax credits for individuals and small businesses.

The event will be held at the Marion Community Building, 191 North Main Street (across from City Hall) in Marion on Monday, March 3, 2014 from 6:30 p.m. to 8:00 p.m. To reserve your spot call contact Billy Martin (828) 652-5506 or Nicole Dozier (919) 856-2146(919) 856-2146 or via email

749px-I-540.svgIt’s a popular argument against NC taking federal money to expand Medicaid under the Affordable Care Act and it goes like this:  ”Well, it’s a good thing to expand Medicaid to 500,000 working, low-income NC citizens, but we just can’t be sure that the federal government will always provide most of the money for the expansion so we had better not help our fellow citizens.”

Poking holes in this argument isn’t hard. After all, many states with Republican governors and legislators realize having the federal government cover 100% of the costs of the expansion for three years and never less than 90% thereafter is a good thing. Indeed, the NC Institute of Medicine estimated that NC actually saves $65 million over the next eight years because state and local governments are already paying so much for mental health and expensive ER care for folks who would get Medicaid coverage. And, of course, there’s the fact that the federal government has never not paid its share of the Medicaid program to any state since Medicaid’s inception in 1965.  Even during last year’s fiercely partisan partial federal government shutdown, Medicaid money kept flowing to the states just as it always has. Finally, of course, Medicaid expansion isn’t permanent. NC legislators can always change their mind and rescind the expansion if indeed, the “money isn’t there.”  Some states did put this in as part of their expansion programs, for example requiring that the expansion automatically end if the federal government’s share ever dipped below paying for 90% of the costs.

To these good reasons for expansion let me add one more:  For NC legislators to take the stance that we shouldn’t take federal money for major state-federal projects in NC because “it might run out” is highly hypocritical. Why? Read More