Any plan Gov. Pat McCrory’s administration presents for expanding Medicaid would have a tough time getting through the state legislature.
A key House member said Tuesday it would probably be premature to consider expanding Medicaid next year with the future of the federal health care law uncertain.
The Republican-controlled Congress is expected to make changes to the Affordable Care Act, under which states had the option to make more people eligible for the government health insurance program. The U.S. Supreme Court will hear a case about who is eligible for tax credits under the law.
Rep. Nelson Dollar, a Cary Republican and a legislator who works extensively on Medicaid policies, said state should wait “until we see what fully develops” in Congress and with the court case. The state then “would have a better idea of what the lay of the land is,” he said.
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The legislature is also considering changes to who runs Medicaid. The state Medicaid office is part of the state Department of Health and Human Services and is run by a state-hired Medicaid director and the agency secretary. Legislators have proposed putting an appointed board of directors in charge of the program.
Dollar said the state needs to decide who runs Medicaid before it takes up the question of expansion.
An estimated 300,00 to 500,000 people would gain health insurance coverage if the state chose to expand Medicaid. The federal government is picking up 100 percent of the cost for newly eligible patients in states that expanded Medicaid. Federal financial support will drop to 95 percent in 2017 and decrease gradually to 90 percent by 2020.
Medicaid covers about 1.8 million low-income children, some of their parents, elderly people, and people with disabilities. The program costs about $13 billion, running on a state budget of $3.7 billion with the federal government picking up the rest.
Senate leader Phil Berger, whose chamber initiated the move last year to reject Medicaid expansion, has not changed his position, said his spokeswoman. Sen. Tommy Tucker, a Republican from Waxhaw, cracked about Medicaid expansion at a legislative health and human services oversight committee meeting Tuesday.
“Everyone’s talking about Medicaid expansion,” Tucker said. “Two are anyway. I’m not one of them.”
Rep. Tim Moore, one of the leading candidates for House Speaker, has said he opposes expansion.
Yet, there have been shifts among legislators. Republican House member Rob Bryan of Charlotte said this fall he was “very, very open” to revisiting Medicaid expansion, according to the Charlotte Observer. House Speaker Thom Tillis during his successful campaign for U.S. Senate said the state should consider it.
When he took office in 2013, McCrory rejected expanding the government health insurance program to more people because, he said, the system was “broken.” Medicaid consistently cost more than anticipated, leaving the legislature scrambling for money year after year to pay the bills. The law he signed in early 2013 rejecting expansion says that the legislature must approve any course reversal.
DHHS Secretary Aldona Wos has said that Medicaid has improved to the point that the state can consider expanding. She said Tuesday that she has another meeting with McCrory scheduled for the week after Thanksgiving to talk about it.
One of the reasons the McCrory administration says it’s ready to consider expansion is that it’s gotten control of Medicaid expenses.
At the oversight meeting Tuesday, the Medicaid’s Acting Finance Director Rudy Dimmling said the budget forecast shows spending in the program will be $68 million below budget, despite an increased cost for prescription drugs.
He cautioned that the costs of flu season and the impacts of enterovirus D68 and Ebola are unknown.