State Senate goes against federal health-care law

The state Senate rejects a federally funded Medicaid expansion to cover the uninsured.

February 5, 2013 

Republican Sen. Tom Apodaca sponsored a bill approved by the state Senate on Monday that, if approved by the House and signed by Gov. Pat McCrory, will prevent the federally supported expansion of health insurance to cover more than a half a million low-income North Carolinians.

Apodaca said the bill’s approval sent a message to Washington, and specifically to President Obama, that the Affordable Care Act will find no welcome nor cooperation from legislative leaders in North Carolina.

“If you want to do it, do it the way you want to do it and leave us out of the equation,” the senator said.

But let’s not talk about the way Washington wants to do it. That was approved by the U.S. Congress and upheld by the U.S. Supreme Court, with the caveat that the law’s expansion of Medicaid would be up to each state.

That brings us to the way Apodaca and the other senators who joined him in the 31-17 vote want to do it.

They want to turn down a federal offer to expand Medicaid, the federal and state health insurance program for the lowest-income families, to cover 500,000 more people in the state. They’re turning it down despite the federal government’s offer to pick up 100 percent of the cost from 2014 to 2016 and 90 percent afterward.

They want to reject $14.8 billion in federal payments from 2014 to 2021 to insure those who would be newly eligible for Medicaid.

They want to forgo the effect that extra federal spending would have on jobs in a state where the unemployment rate is above 9 percent.

They want to dismiss an opportunity to improve the health of low-income people in a state that ranks 38th in negative health outcomes such as cancer, infant mortality, diabetes and cardiovascular deaths.

North Carolina is left out, indeed. And for what reason?

Senate Republicans say the Medicaid deal looks appealing, but it’s a “bait-and-switch.” They say the program will grow larger and eventually the cost to the state will grow. So they say the prudent course is to reject the federal government’s generous offer.

But the Senate bill isn’t a long-term cost-saver. It’s a costly rejection of both federal funds and long-term savings in health care costs. Even McCrory appears uneasy with letting this much money go. “We believe additional time is necessary to evaluate the serious financial ramifications of Senate Bill 4 to North Carolina taxpayers,” wrote Fred Steen, the governor’s chief lobbyist.

Despite what the Republican senators say, the reason behind this bill isn’t prudence. It’s spite.

Basically, Republican senators used the legislative process to take a slap at a just-re-elected president they don’t like. Their action would prohibit the state from establishing a health care exchange as required by the Affordable Care Act. And it will continue having hundreds of thousands of uninsured North Carolinians rely on the emergency room as their only resort for health care.

The proposed Medicaid expansion would include those making 138 percent or less of the federal poverty level, or $31,809 for a family of four. It would be a Godsend to the working poor in North Carolina. But their representatives in Raleigh – yes, legislators represent the poor, or are supposed to – are taking a purely ideological stand and sacrificing the health of these people in the process.

Oh, and by the way, it’s useless. For people who make law, it’s mighty curious how they don’t seem to understand that North Carolina is subject to federal law, and thus the state has no choice but to have a health-care exchange. The difference is, if the state doesn’t set it up, thus providing personnel who know the state and would be close to customers, the federal government will come in and do it anyway.

Republicans are mad because President Obama won re-election. They need to get over it and get back to the business of serving the people. All of the people.