Health insurance for more than a million North Carolinians is at stake, and Gov. Pat McCrory has two options: He can take the initiative to protect the people he has sworn to represent or he can sit back and let external forces decide our destiny.
Nearly 560,000 people have signed up for Affordable Care Act plans in North Carolina, and many of them receive tax credits to help pay their premiums. Thanks to outreach efforts by nonprofits, insurers, insurance agents and hospitals, our state ranked fourth in Affordable Care Act signups nationally.
Despite these impressive results, there are still more than 500,000 people, many of them the working poor, who do not qualify for North Carolina’s Medicaid program and who do not earn enough to purchase private insurance. Health reform set aside money for our state to provide this population with coverage through Medicaid, but first state leaders must consent to using these funds for that purpose. So far the governor and state legislature have left the money in Washington.
There was some hope that McCrory would follow the lead of other conservative state executives, such as Gov. John Kasich in Ohio and Gov. Mike Pence in Indiana, and push for a solution to this coverage gap emergency. He has announced on several occasions that he will release a state-specific plan for using federal Medicaid funds to expand health insurance to those locked out of the system.
In December, McCrory said he was not yet ready to reveal his roadmap to expanding coverage. In the State of the State address earlier this month, the governor again said he was not ready. A few days ago, he announced he would wait for a decision from the U.S. Supreme Court on the latest legal challenge to the Affordable Care Act before he makes any recommendations.
That case, known as King v. Burwell, contends that people living in states that refused to establish state-based insurance marketplaces, as outlined in the federal health reform law, cannot get tax credits to help pay for insurance coverage. If the Supreme Court sides with the plaintiffs and strikes down the tax credits, most of the 560,000 enrollees in ACA plans in North Carolina would drop coverage. Private health insurance premiums for everyone would jump, and our uninsured rate would spike.
Now comes the governor’s moment.
He, along with legislative leaders, could change course and circumvent the Supreme Court by re-establishing state control over our insurance marketplace. In fact, most of the pieces are already in place. Our Department of Insurance is proactive about reviewing insurance policies. Our health care and insurance communities meet regularly and could easily form an oversight board. Our outreach and enrollment efforts are national models. All we need is for the governor to work with legislators to vest these organizations with the power to form a state marketplace.
McCrory then could release a state-specific plan to tap federal Medicaid funds to expand coverage to 500,000 additional people. This would boost local economies still staggering from the Great Recession. It would allow tens of thousands of women access to preventive screenings like mammograms and pap smears. It would allow thousands of people suffering from the disease of addiction to obtain the long-term treatment they need.
Closing this gap in coverage would not only save lives, it also would help rescue rural hospitals, which serve a disproportionately high percentage of uninsured patients and are on the verge of financial collapse.
McCrory may not realize it, but insurance for more than a million North Carolinians will be a touchstone for his administration. Claiming he has no control over the issue will not do because it’s not true. I suspect the governor and legislature will meet this test. Surely, they will not throw up their hands and surrender our fate to a few fickle Supreme Court justices and a deadlocked Congress. After all, what is the purpose of holding political office if not to secure the well-being of our citizenry?
Adam Linker is co-director of the N.C. Justice Center’s
Health Access Coalition, a statewide nonpartisan consumer advocacy organization.