RWJA new report from Manatt Health Solutions on behalf of the Robert Wood Johnson Foundation finds that states that have tapped federal funds to expand Medicaid are seeing significant financial benefits. By the end of 2015 the savings and revenues across the eight states examined in the report are expected to exceed $1.8 billion.

This is consistent with the county level examination of expansion in North Carolina commissioned by the Cone Health Foundation and the Kate B. Reynolds Charitable Trust. That study, using conservative estimates, found that the savings and revenues more than offset the costs of expansion through 2020.

The states featured in the report — Arkansas, Colorado, Kentucky, Michigan, New Mexico, Oregon, Washington, and West Virginia — had direct budget savings from reduced spending on the uninsured, they experienced increased tax revenue from the new flow of federal funds into the state, and they realized additional savings from switching some existing Medicaid patients into the expansion program.

A source of significant savings, for example, comes from pregnant women. North Carolina has traditionally covered pregnant women in Medicaid up to 185 percent of the federal poverty level. This coverage, however, is only for pregnancy related services. Also, once a woman has the baby she oftentimes loses Medicaid because coverage for parents is quite stingy.

After expansion, pregnant women above 133 percent of federal poverty level would qualify for full Medicaid coverage. And, instead of the lower match rate, the federal government would pay 90 percent of the costs for these women. Once the baby is born many women would then be able to continue coverage through Medicaid. This would result in healthier babies, healthier parents, and major savings for the state.

The report notes that states will also garner savings in behavioral health and among the medically needy population.

States that opted to expand Medicaid early will have the largest benefits, but there are still plenty of positives for states like North Carolina that haven’t hit the leader board yet. The final year for the federal government to pay the full cost of expansion is 2016 so we need to act fast or our people, and our economy, will miss out on a much needed boost.


A new report from Cone Health Foundation and Kate B. Reynolds Charitable Trust finds that North Carolina lost out on billions of dollars and thousands of jobs by refusing to close the Medicaid coverage gap in 2014 and 2015. If the state acts in 2016, however, we can recoup some lost ground by covering 500,000 more people. Such a move would create 43,000 new jobs by 2020 and reap $1 billion in tax revenue for the state and counties. Closing the coverage gap would save the state budget more than $300 million by 2020.

As followers of this blog know the state had a chance, starting in 2014, to expand Medicaid eligibility to all individuals and families earning less than 138 percent of the federal poverty level. More than half the states have now opted into this deal and they are attracting a huge return on investment. This new report is the first of its kind in the nation that takes a detailed look at every county in the state and uses a nationally respected model to estimate the impact of Medicaid expansion on tax revenue, job creation, business activity, and coverage.

The results are startling. In Robeson County expanding Medicaid would generate more than 700 jobs. In Moore County it would create nearly 500 jobs. In Nash County it would create more than 300 jobs. This is the equivalent of a fleet of new large employers locating in dozens of communities across the state. The increased economic activity will produce more county tax revenue at a time when many local governments are sputtering by on fumes. For Wake County, Medicaid expansion would net more than $25 million in tax revenue. It would earn Guilford County more than $11 million.

New data confirms in finer detail what we have always known, expanding Medicaid eligibility is a no-brainer. Thankfully, Gov. McCrory seems to be moving to the right (or should I say correct) side of this issue. Now that the federal government is allowing governors and legislators the flexibility to design state-specific expansions Wyoming, Indiana, Utah, and Tennessee — hardly redoubts of liberalism — are starting to embrace expansion. We should follow suit.

This is a rich report that deserves a close reading. You can find some reporting on it here, here, here, and here.




If there’s been one area in which the current leadership of the General Assembly has been at its most cynical when it comes to directly contradicting past promises and rhetoric, it’s almost certainly in the area of legislative process. It’s gotten to the point at which it seems that scarcely an important piece of legislation advances on Jones Street without some kind of abuse of legislative rules (or, at least, the spirit thereof). Whether they’re crafting budgets in secret,  holding unannounced, middle-of-the-night sessions, providing lack of time and opportunity for public comment or just springing entirely new legislation out of thin air as last-minute  amendments, both the House and the Senate have frequently seemed intent of bending every guideline of fair play and open government.

And, of course, the amazing thing about all of this is that it’s not even necessary even from a crass, down-to-brass-tacks political perspective. The leaders in both Houses have huge, rubber-stamp majorities that make such shenanigans utterly unnecessary.  Sometimes it feels as if leaders are engaging in such exercises just because they can.  See for example, last week’s decision by House leaders to spring a last-minute, out-of-nowhere amendment on Senate Education Committee chairman Jerry Tillman on Common Core legislation.

So, with the final days of the 2014 session apparently upon us, observers of the General Assembly will do well to pay very close attention over the next week or two. Indeed, the House Finance Committee meets at 5:00 pm today to take up a bill that’s been sitting on its calendar since last summer and that will almost certainly be gutted and entirely rewritten with a “committee substitute.”

The bottom line: Notwithstanding the Senate’s just-for-show talk of making budget negotiations open, it’s almost a certainty that the upcoming days will  feature loads of secrecy and bad, behind-closed-doors lawmaking. Stay tuned and watch closely if your stomach can take it.


Golf ball on teeState lawmakers are rushing through a bevy of important and destructive bills during the 2014 short session — often with remarkably little process or debate.  The Senate is even going so far as to take the most important bill of the session — the 274-page budget bill — from its moment of unveiling to final passage in just 48 hours. Meanwhile, House Speaker Thom Tillis threatened his chamber with a rare Friday session if they didn’t speed along a bill to legalize fracking.

Ah, but happily, the mad rush doesn’t apply to all matters. According to an announcement emailed out early this afternoon by the House Commerce and Jobs Development Committee, that august body will be devoting two full hours of precious short session time next Thursday to the subject of golf. This is from the announcement:

2013-2014 SESSION

You are hereby notified that the House Committee on Commerce and Job Development will meet as follows:

DAY & DATE: Thursday, June 5, 2014
TIME: 10:00 AM
COMMENTS: This is an informational meeting. The objective of the NC Golf Economic Impact meeting is to review the historic and ongoing economic contributions golf has made to the state. When examined in a historic context one reaches a simple conclusion: NC has been very good for golf and golf has returned the favor in kind. Read More


This morning’s edition of Raleigh’s News & Observer gets it just about exactly right with a full-length  editorial on the return of Moral Monday protesters to the state capital and the conservative legislature’s heavy-handed attempt to muzzle them:

“Tuesday, the marchers will return, following Memorial Day. And Republicans may be sure they’ll be back, Monday after Monday. More enlightened leaders might talk to the protesters (who include blue collar workers, teachers, lawyers and doctors) to at least hear their viewpoints.

Alas, the Republicans now in charge on Jones Street prefer ignorance of the opposition, the better to do their damage to average North Carolinians without facts and conscience getting in the way. They’ll stumble on, wreaking legislative havoc as they seek to destroy what’s left of environmental regulation and to cut taxes even more for the wealthy, who benefit most from their actions.

Meanwhile, a movement grows, literally across the country, thanks to the hearty souls who have dared to go to the considerable trouble of arriving at the Legislative Building knowing they’ll face only disrespect from those who are supposed to serve them….

These protesters have done a public service, pure and simple. They have spoken eloquently and loudly, even when they do not speak at all.”

Today’s protest start at 12:00 noon on Halifax Mall behind the Legislative Building. Read the entire N&O editorial by clicking here.