Lawmakers differ on Cooper Medicaid expansion


By Jon Hawley
Staff Writer

Monday, January 9, 2017

Area lawmakers differ on Gov. Roy Cooper’s call for expanding Medicaid under the Affordable Care Act.

Republicans call the move illegal and say it won't work, while a Senate Democrat said she welcomed Cooper’s initiative — even though it appears to violate a state law passed by the General Assembly.

Addressing business leaders last week in Durham, Cooper said he will request the federal Centers for Medicare and Medicaid Services approve an amendment to the state's Medicaid plan to expand coverage under the health insurance program for the poor and elderly.

States commonly amend their Medicaid plans, but the expansion Cooper is seeking would be a major, potentially costly change. The expansion is a provision of the Affordable Care Act that would extend government-provided health insurance to more North Carolinians with incomes near the federal poverty level. According to a widely cited 2014 study, the expansion would bring billions of dollars in federal aid to North Carolina and insure almost 500,000 residents currently without health insurance.

Based on those benefits, Cooper believes North Carolina needs the expansion. According to published reports, he also proposed asking hospitals in North Carolina to pay the state's share of the expansion costs. The federal government has offered to pay 95 percent of expansion costs this year and, from 2020 and on, 90 percent of those costs.

Asked about Cooper’s plan last week, state Sen. Bill Cook, R-Beaufort, rejected it, calling the plan a costly and “illegal power grab.”

“Gov. Cooper does not have authority to unilaterally expand Obamacare,” Cook said in an emailed statement, using the term commonly used for the ACA. “My position has not changed — expanding Medicaid would cost North Carolina citizens an additional $2 billion-plus over the next 10 years. … We plan to ask Congress and (the Centers for Medicare and Medicaid) to disapprove Cooper's illegal power grab.”

State Rep. Bob Steinburg, R-Chowan, also believes it's illegal for Cooper to try to expand Medicaid. He noted the 2013 law passed by the General Assembly that states in part that “no department, agency or institution of this state shall attempt to expand the Medicaid eligibility standards” set in 2011 unless directed otherwise by the General Assembly.

Cooper has said the 2013 law wrongly “invades on the core executive authority of the governor” to provide for public health in the state. He said he hoped to work with lawmakers on the expansion, but suggested he’s also prepared to go it alone, stating, “Someone needs to take action.”

Steinburg said Republican lawmakers have worked for years to rein in Medicaid costs, turning the program’s deep deficit into a major surplus last year. State health officials reported last May that much of the Medicaid savings came from lower-than-expected enrollment and improved federal funding.

Steinburg described Cooper’s efforts as an “exercise in futility in the long term,” noting Republicans in Washington, D.C., who now control both houses of Congress and the presidency, plan to repeal the ACA. That planned repeal also means there’s too much uncertainty in health care to consider expanding Medicaid even if hospitals will cover the state’s costs, Steinburg said. Hospitals don’t know what the expansion would cost them, he noted.

Disagreeing with Cook and Steinburg, state Sen. Erica Smith-Ingram, D-Northampton, welcomed Cooper's efforts.

“I really hope it is a successful attempt” to expand Medicaid, she said.

Citing numbers from the 2014 study, Smith-Ingram said North Carolina “left on the table” about $6 billion in federal funds over 2014 and 2015 that could have helped uninsured people, hospitals and the state’s economy.

Asked if Cooper's move was legal, and whether the CMS could override state law to expand Medicaid, Smith-Ingram conceded the governor’s request is “probably unprecedented.” She went on to say, however, that the expansion is needed because “this is an urgent matter.”

Smith-Ingram also said she believes hospitals would benefit from the Medicaid expansion even if they help pay for it. The expansion would cover patients hospitals don't get any money for now, she noted.

State Rep. Howard Hunter III, D-Hertford, who represents part of Pasquotank County, could not be reached for comment for this story.