The debate over Medicaid expansion in North Carolina

Buckley Report
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There is a looming battle in North Carolina and some are framing it as a battle of life and death.

When President Barack Obama signed the Affordable Care Act on March 23, 2010, few people were thinking about a provision in it that allows states to expand Medicaid, with 90 percent of the cost being borne by the federal government.

Congress created Medicaid in 1965 to provide health insurance and care to children and America’s poorest people who otherwise couldn’t afford it.

Fifty-five years later, millions are still in that position – caught between being not poor enough to qualify for Medicaid but being nowhere close to being able to afford private health insurance.

“These are poor families that don't have other options other than showing up in the hospital emergency room which is very expensive,” said Susan Shumaker, of the Cone Foundation.

Shumaker is a former nurse and hospital administrator, so she’s been on the front lines and wants to see Medicaid expanded in North Carolina, as 34 other states have.

“I think it's become a very partisan issue, sadly, and we're talking about people's health,” Shumaker said.

State Senator Joyce Krawiec wants the same thing and feels the most important first step is reforming the state’s current Medicaid program from a traditional, fee-for-service one to what she believes will not only be more cost-effective but will also produce better health outcomes: a managed care model.

In fact, that’s been North Carolina’s plan since 2015 when they started working to transition NC Medicaid from fee-for-service to managed care. It was set to begin on Nov. 1, 2019, until Gov. Roy Cooper’s administration put it on hold.

“To me, that was strictly political because they had everything they needed to go forward,” Krawiec said.

Shumaker says she’s not opposed to reform.

“I think having reform and expansion at the same time would be ideal,” says Shumaker.

But Krawiec says it’s wiser to do big projects one at a time and many states that have chosen to expand Medicaid too quickly have found it has cost billions more than they anticipated.

“Most every state has either doubled, tripled or quadrupled what they estimated,” said Krawiec, and that crowds out other state priorities. “You have to fund the Medicaid. That's the serious problem New York has, now, with the $6 billion deficit. I don't want that to happen to North Carolina. I don't want us to be looking to say, ‘We can't give teachers a raise, we can't fund those classrooms like we've been trying to do.’”

Hear both sides’ arguments in this edition of the Buckley Report.

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