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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.

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.

Bills filed in the NC Senate and House today (See SB4) declare that NC must reject federal grant money to set up a Obamacare health exchange and that NC should not expand Medicaid that is 100% paid for by the federal government over the next three years under Obamacare (and 93% thereafter).  There are plenty of consequences here for NC, but here are three main ones:

1.  NC will have to return most of the $74 million federal grant it just got to help set up the exchange.  The majority of this money is to be for modernizing the state computer systems under Medicaid.

2.  Only legal immigrants under 138% federal poverty level will be able to get help with health care costs while 500,000 of NC’s citizens under 138% federal poverty level will be barred from getting affordable health care under Medicaid. Read More

gov jan brewerRepublican Governor Jan Brewer is expanding Medicaid in Arizona under Obamacare for some very practical reasons (excerpt below from the Yuma Sun):

“In the end, Brewer felt she could not turn away nearly $8 [b]illion in federal assistance over the next four years, creating and saving thousands of jobs and protecting rural and “safety-net” hospitals, she said.

“Our hospital presidents and CEOs understand the growing cost they face in providing care for the uninsured. These costs are real and they are not just absorbed to the hospital’s bottom line. No, ultimately they are passed down to Arizona families” through premium increases, Brewer said.

“With my plan, we can not only begin to get a handle on these costs, we can throw a lifeline and a safety net to rural hospitals like Yuma Regional Medical Center,” she said.

In addition, Brewer said, the federal funds are needed for the state to remain competitive on national and global basis.  “I’ve never been a supporter of the Affordable Care Act. I’m uneasy with the federal government playing such a role in private individuals’ health-care decisions,” she noted.

But the decision was not about whether or not the law should exist. “It’s the law of the land. Our decision is about whether we will take the action that most benefits Arizona families and businesses,” she said.”