Gov. Roy Cooper plans to take immediate executive action aimed at expanding Medicaid, defying a state law and setting up a confrontation with the Republican-dominated state legislature.
Addressing a group of business leaders at an economic forum Wednesday morning, the governor – who was sworn into office on New Year’s Day – said he would file an amendment to the state Medicaid plan by Friday. The new plan would allow hundreds of thousands more people to sign up for government health insurance.
The amended plan would expand Medicaid as outlined in the Affordable Care Act and would have to be approved by federal officials. But Cooper has only about two weeks until President-elect Donald Trump, an adamant opponent of the law dubbed Obamacare, takes office. Trump has vowed to get rid of it.
Under Medicaid, the state and federal governments pay medical costs for low-income families and individuals, mostly poor children, some of their parents, the elderly and disabled. Expansion under the Affordable Care Act would raise income limits to cover more people, including more childless adults.
State leaders have refused to expand Medicaid coverage. The Republican-dominated legislature went so far as to approve legislation in 2013 that bars the executive branch from expanding the program.
Cooper, a Democrat, said in a news conference following his talk that the law impinges on “the core executive authority of the governor to accept federal funds to look out for the health of the people.”
The issue could end up in court, but Cooper said he would rather avoid a dispute. He said he hopes that legislators “will be receptive or at least let us do it without trying to stop us.”
But Republican leaders in the General Assembly said they are working to stop an expansion. Senate leader Phil Berger, an Eden Republican, said legislative leaders will send a letter to Congress and federal Medicaid officials asking them to deny Cooper’s request.
“Just days into his term as governor, Roy Cooper already intends to violate his oath of office with a brazenly illegal attempt to force a massive, budget-busting Obamacare expansion on North Carolina taxpayers,” Berger said in a statement.
“Cooper is three strikes and out on his attempt to break state law: he does not have the authority to unilaterally expand Obamacare, his administration cannot take steps to increase Medicaid eligibility and our Constitution does not allow him to spend billions of state tax dollars we don’t have to expand Obamacare without legislative approval.”
Two Republican leaders in the state House, Speaker Tim Moore of Kings Mountain and Majority Leader John Bell of Goldsboro, issued a statement equating Medicaid expansion to a tax increase.
“Gov. Cooper proposed raising taxes on North Carolinians today, just over 72 hours into office,” the statement said. “Fortunately, Gov. Cooper lacks the authority to implement his proposed plan and cannot unilaterally raise taxes on the people of North Carolina.”
Medicaid now covers 1.9 million North Carolinians and costs $14 billion a year, two-thirds of which is paid for by the federal government. Democrats say expanding it to more low-income people would boost the economy. Republicans say the state’s share of rising costs would be too expensive.
Sen. Dan Blue, the Senate minority leader and Raleigh Democrat, called expansion “a sound economic move” that will help rural communities.
“This is a vital step in protecting North Carolinians who have been shut out of the process over the past three years,” Blue said in a statement. “We need to put political ideologies aside and act in the best interest of the people we represent.”
Cooper, too, positioned Medicaid expansion as an economic development move, introducing it with a teaser.
“What if I were to tell you that we have the opportunity to bring in $2 billion to $4 billion a year in investment in North Carolina?” he asked the audience of about 900 at the annual economic forum sponsored by the N.C. Chamber and the N.C. Bankers Association. “What if I told you we are looking at 20,000 to 40,000 good-paying jobs?”
Cooper said he knew there were skeptics in the audience who don’t like government programs, but told them: “You’re already paying for it. North Carolina is paying federal taxes that are going to other states.”
He added that “conservative Republican governors” – including Vice President-elect Mike Pence of Indiana, Chris Christie of New Jersey and John Kasich of Ohio – agreed to Medicaid expansion in their states because they “understood this was an economic decision.”
The federal government would provide 95 percent of the cost of Medicaid expansion; the state would be responsible for the remaining 5 percent. The state’s share would grow to 10 percent by 2020.
Cooper said up to 650,000 North Carolinians would benefit from expansion of the program.
Help from hospitals?
Cooper wants the state’s hospitals, which would be “by far the largest beneficiaries” of Medicaid expansion, to cover the state’s costs by agreeing to a “mandatory assessment.”
“I would encourage this group to encourage the hospitals to do this,” he told the gathered executives.
Otherwise, Cooper said, the money would have to come from taxpayers.
The N.C. Hospital Association released a statement in support of Medicaid expansion, but added: “Given the complexity of the issue and the process, we believe coverage expansion can only happen through a bipartisan, collaborative effort. We are prepared to work with the Governor, the General Assembly, and our members of Congress to achieve this goal.”
Cooper said he was acting now because time is of the essence “before the turmoil begins” with regard to the Affordable Care Act. He indicated he has already been in discussions with federal officials.
“We have found very receptive people in Washington who are working with us and who are ready to do this,” Cooper said.
Cooper added that “Medicaid is one of the programs most likely to be preserved” going forward. And even if it is altered, expanding Medicaid coverage now would put North Carolina “in a much better position to make sure it gets its fair share.”
Joan Alker, executive director of the Center for Children and Families at Georgetown University’s McCourt School of Public Policy, said the state has time to expand its Medicaid program even with congressional Republicans eager to repeal the Affordable Care Act.
Medicaid state plan amendments are usually approved quickly, she said. Louisiana put its Medicaid expansion plan in place in just a few months.
Last year, Louisiana’s governor signed an executive order expanding Medicaid on Jan. 12, and people started enrolling on June 1.
Congress hasn’t detailed how it will repeal the ACA, Alker said. While a repeal is expected to include Medicaid expansion, she said, some in Congress are talking about delaying the impact for months or years.