Medicaid expansionIn case you missed it, the best editorial of the weekend dealt with the most important failure of North Carolina’s political leadership in recent years. The essay in Raleigh’s News & Observer was entitled:

NC losing funding and savings with Medicaid holdout: By balking on Medicaid expansion, N.C. forgoes billions of dollars and a chance to cut costs.”

As the editorial noted:

“In medicine, the small things can matter most. And it is the neglect of the small things that can lead to the biggest costs.

That’s why preventative care is so important and early intervention so significant. And that’s why North Carolina’s stubborn refusal to expand Medicaid is so wildly irresponsible and hugely expensive. As a result of its intransigence, the Republican-led General Assembly is struggling to find tax revenue on one end and turning away billions of dollars on the other.”

The piece goes on to explain how North Carolina’s award-winning nonprofit Medicaid manager, Community Care NC, is saving millions upon millions of dollars and thousands of lives already and to lament the toll in both categories that is being taken by the state leadership’s pigheaded refusal to close the Medicaid gap for hundreds of thousands of lower-income, working people. It also cites report which holds up the astounding amount in federal funds the state is foregoing:

“The report estimates that forgoing federal Medicaid expansion from 2013 to 2022 will cost North Carolina $39.6 billion. In addition, the state’s hospitals will lose out on $11.3 billion in federal funds intended to offset cuts in their Medicare and Medicaid reimbursements as required under the Affordable Care Act, which anticipated that all states would expand Medicaid.

That’s more than $50 billion in federal funding forgone over 10 years. Meanwhile, the state would have to spend about $3 billion for its share of expansion. That is a mindboggling deal to refuse so that conservatives can express their pique over ‘Obamacare.’

Republican leaders say they’re worried about being saddled with a higher entitlement cost if the federal government reneges on its promise to pay its full share, but the design and history of Medicaid do does not support that concern. Meanwhile, there are billions of reasons to expand Medicaid now.”

Amen. Read the entire editorial by clicking here.


The beneficial impacts of Obamacare continue add up, but unfortunately, North Carolina isn’t getting its fair share. That’s that’s one of the takeaways from a new report distributed yesterday on the fifth anniversary of the law. As health policy expert Tara Culp Ressler of Think Progress reports:

“According to a new report from the Department of Health and Human Services (HHS), hospitals saved at least $7.4 billion last year, thanks in large part to reforms under Obamacare. The savings reflect a reduction in the so-called “uncompensated care” that hospitals provide to uninsured Americans, and are even greater than HHS officials predicted they would be at the beginning of this year.

Since people without insurance typically don’t have any means to cover their medical bills, the cost of their treatment ends up falling on the hospital itself. Therefore, as more people gain coverage, it become less expensive for hospitals to care for their patients. More than 16 million previously uninsured Americans have gotten covered under Obamacare, contributing to the biggest drop in the national uninsurance rate over the past four decades.”

If states like North Carolina had gotten on board with closing the Medicaid gap, things would be even better:

“The savings have been most pronounced in the states that agreed to accept Obamacare’s optional Medicaid expansion, which seeks to extend public insurance to additional low-income people. Nearly 70 percent of the savings documented in the HHS report — a total of $5 billion — occurred in the 29 states that have expanded Medicaid. And, if every state had agreed to add more people to their Medicaid rolls, their hospitals could have saved an extra $1.4 billion.”

In other words, here’s more confirmation that,  in addition to helping hundreds of thousands of working people in need, Medicaid expansion would do wonders for some of the most important businesses in North Carolina (especially in rural North Carolina) hospitals. It’s hard to imagine that state leaders can resist taking this obvious and long overdue step much longer.


Out-of-state activist J. Scott Moody will be making the rounds on Monday in North Carolina to say that expanding Medicaid will hurt our economy.

Moody is from a South Carolina outfit called State Budget Solutions and he travels the country speaking out against policies disfavored by conservatives. His schtick is releasing cut-and-paste reports showing the economic harm done by the programs he opposes.

For example, in 2012 he lit off to New Hampshire to warn that allowing same sex marriage in that state would result in economic devastation and a “demographic winter.” You have to read the entire news article of his visit to capture his arguments in all of their glory, but this is one of my favorite parts:

Also, according to Moody, when same-sex couples adopt, they place the child in a situation where one or both of their parents isn’t their biological parent. However, according to Moody, statistics have shown that a relationship with a stepparent is not the same as a relationship with a biological parent and stepparents tend to not have the same bond or pay the same attention as the biological parent. Moody did not provide charts or actual sources for this claim.

These days Moody is taking a break from attacking adoptive parents and is focusing on Medicaid expansion. Moody has made presentations in several states and published opinion pieces arguing that an expansion of the public sector will crowd out private sector spending. This analysis is about as sophisticated as his arguments that gay marriage will destroy the economy and that stepparents don’t pay attention to their children.

Actual economists have responded to Moody everywhere he has spoken to point out that he is wrong. A good example is from Dr. Sven Wilson at BYU when Moody visited Utah to warn them of the dangers of federal funds flowing to the state. Again, you should read the entire piece but here’s a taste of Wilson’s response:

Many economists argue that spending on Healthy Utah will further expand the economy by generating new jobs and new private spending as the money works its way through the economy. Economists call this effect a multiplier. As a conservative, free-market economist, I think multipliers are generally small. But no serious economist of any political stripe thinks the multiplier is negative, which is what Moody is suggesting.

Imagine someone saying that when tourists spend their money in our state, their purchases end up costing us jobs and hurting our economy. Who would believe that? But that is exactly the argument Moody is making about Healthy Utah.

Luckily, we already have a study on the economic impacts of Medicaid expansion in North Carolina using respected REMI models. That study concludes that expansion will grow our economy, create 43,000 jobs, and provide much needed revenue to county and state budgets. It will also provide affordable coverage to 500,000 North Carolinians and bolster rural health care in the state. States that have already expanded coverage, like Kentucky, are seeing these positive economic predictions realized.

We aren’t seeing the winter Moody predicted in 2012. Instead the economy keeps heating up despite gay marriage sweeping the nation. I suspect we will see similar results as more states expand insurance coverage.



Be sure to check out Tazra Mitchell’s excellent essay over on the main Policy Watch site this afternoon: “Governor McCrory’s flat budget proposal ignores research and reality.” As Tazra explains, the state is cutting essential services to provide enrollment growth increases in education and health care. As a practical matter, everything else remains frustratingly and destructively stuck in neutral:

“With his 2015-2017 budget, Governor McCrory chose to ignore the need for reinvestment in public education, health, safety, and the other programs that improve well-being for us all. Total state investments under his 2016 fiscal year budget proposal would be 6.1 percent below pre-recession levels, adjusting for inflation. North Carolina’s lived experience shows us this is the wrong way to go—in past economic recoveries, state investments returned to and exceeded pre-recession levels far more quickly. Our former leaders understood that investing in the infrastructure of opportunity spurs economic growth.

Governor McCrory’s spending plan, in large part, freezes state investments at a time when his priority should be to roll back harmful budget cuts enacted since the downturn. His budget for the 2016 fiscal year increases year-to-year spending by nearly $439.8 million, or two percent, but the costs of enrollment growth in public schools, the UNC system, and the Medicaid/Health Choice programs are estimated to slightly exceed that year-to-year increase. That means every new dollar, on net, is dedicated to funding enrollment growth rather than replacing budget cuts that stifle economic mobility or pursuing new initiatives to position the state competitively.

And despite promises that the 2013 tax cut for the wealthy would deliver a huge boom to the economy, North Carolina has experienced nothing of the sort. Job growth has largely followed national trends in recent years, but we still have not gotten back to the level of employment—when accounting for population growth—that was the norm before the recession. Wages in North Carolina have slipped further behind the national average and are not even keeping up with inflation, which means many people’s paychecks do not go as far as they did before the downturn.

So the promise of an economic boost from tax cuts has failed to pan out, but state leaders are sticking with those cuts rather than reinvesting in the long-term building blocks of opportunity and prosperity like schools and environmental protection.”

Click here to read the entire article.



Rep. Renee Ellmers showed up to a panel at the South By Southwest conference Sunday to talk about how big data can transform poverty policy. Ellmers, who was also here on Saturday to talk about broadband competition in the communications space, appeared at this panel in place of Rep. John Delaney (D-MD), who sponsored a Social Impact Bond bill last summer that was one of the topics of discussion.

Ellmers spoke alongside Kevin Corinth of the conservative American Enterprise Institute and Michele Jolin, Managing Director of America Achieves.

The repeated theme of the session focused on making results-oriented, evidence-based policy solutions.

Corinth emphasized divorcing emotion from policy decisions and the importance of crafting legislation that works for people rather than causes.

Ellmers agreed that there is “a lot of emotion on both sides” of the political spectrum and that a results-oriented effort presented a bipartisan opportunity to address issues like poverty, homelessness and mental illness.
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