I’ll address Medicaid first. The Budget and Tax Center has written a brief on why the Medicaid expansion is critical. In that paper they explain that Medicaid would provide health insurance to hundreds of thousands of North Carolinians and bring a flood of federal money in to the state, which would boost job creation and support health care providers. It would help hospitals that see a large percentage of uninsured patients, especially in rural areas of our state.
We would all pay for not implementing the Medicaid expansion. The American Academy of Actuaries says that private insurance premiums will increase faster in states that do not expand Medicaid. That is because there will be more cost shifting in those states with higher uninsured populations. It is also because more folks with more health needs will get subsidies to purchase private insurance if we do not expand Medicaid. That will mean the insurance pool will be filled with people who are not as healthy, which will result in higher premiums.
More businesses with more than 50 employees will pay penalties for not providing health insurance if we do not expand Medicaid. Under health reform, if you own a business with more than 50 employees and you do not offer affordable insurance and at least one of your employees gets federal subsidies to purchase private insurance, then you will be fined. If, however, we expand Medicaid then fewer employees will receive a subsidy, which means fewer businesses will get penalized. There is no fee for a business when employees get Medicaid.
On the exchange it was not surprising to hear Berger say that his caucus is not excited about a state-based exchange. But there is no reason at all to reject a hybrid exchange, or, as it is officially called, a state partnership exchange. Having a partnership exchange means that the federal government pays us to conduct our own consumer assistance program and review insurance plans sold in the exchange. North Carolina is a pioneer in the area of consumer assistance for insurance problems. To turn that function over to the federal government just feels unpatriotic. Maybe I’m just too prideful about North Carolina.
It is also good for North Carolina to review insurance plans sold in our exchange. If insurance companies or consumers have questions about plan approval we know the North Carolina insurance commissioner and we know how to contact him. If I had similar concerns in a federal exchange I would have no clue who to call.
Rejecting a partnership exchange is just saying that we want no say over how things operate in North Carolina. I can understand Berger not wanting to take full ownership of the exchange but rejecting a partnership makes no sense at all.
Every day that North Carolina spends running away from health reform is a day that we get further from where we will need to be one day. Putting off decisions now will only increase our pain in the future. States that embrace reform will get all of the benefits while we get left behind.
Adam Linker is a policy analyst at the North Carolina Justice Center’s Health Access Coalition.