Friday, 27 September 2019 14:34

Experts discuss implications of Medicaid expansion in N.C.

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RALEIGH — Expanding Medicaid in North Carolina would reverberate throughout the state in disparate yet significant ways, affecting rural communities, people without jobs, as well as the uninsured and insured alike.

Thought leaders gathered Tuesday, Sept. 24, in Lexington for the first in a series of discussions on Medicaid and health care. N.C. Institute of Political Leadership’s 2019 Hometown Debates Series will continue throughout the state in October. Tuesday’s event included former state representative Nelson Dollar; state Democratic Party Chair Wayne Goodwin; Brendan Riley, senior policy analyst at the N.C. Justice Center; and Roy Lenardson, government affairs director at the Foundation for Government Accountability.

Goodwin and Riley, echoing a recurring theme from Democrats and Gov. Roy Cooper, were quick to support Medicaid expansion. Medicaid expansion is the biggest reason lawmakers have yet to pass a new budget.

Cooper wants it, and Republicans don’t. Thus the stalemate.

“We should have expanded Medicaid back in 2014, but we have the opportunity to do it now,” Riley said.

Dollar brought up House Bill 655, the Republicans’ plan to provide health care to the more than 600,000 North Carolinians without it. The bill, called N.C. Health Care for Working Families and originally filed in April, has stalled in committee.

Work requirements have been, and will continue to be, a primary point of debate. “Do you want to expand Medicaid to able-bodied adults?” Lenardson asked.  He supports a work requirement.

Said Goodwin, “…by definition, the vast majority of people benefitting from it [Medicaid] are working families.”

“Let’s be clear about what work requirements are,” Riley said. “They sound good in theory, but they do nothing to boost employment. In fact, what they do is erect barriers, bureaucratic barriers, to coverage. When people need it most, we’re going to block you from coverage by erecting these reporting requirements.”

When asked how Medicaid would affect the state budget, Dollar said, “It should be a net gain to the state budget … you want the benefit of the program, but you certainly have to be careful because it is an entitlement program.”

Lenardson looked at the money issue from an economic perspective.

“Medicaid patients pay less for care to hospitals, you and I pay more,” Lenardson said.

“Medicaid costs shift the cost of your premium onto the private payer — that’s how they pay for it. They raise private premiums to pay for the loss that they have in Medicaid.” He later added, “If you expand eligibility and you expand Medicaid, it won’t matter what you do. You will never control cost.”

Goodwin attributed the lack of Medicaid expansion to politics. That may be true, but that pendulum swings both ways. Already, Lenardson said, 12,000 North Carolinians sit on Medicaid waiting lists.

“Rural North Carolina is losing out under the status quo,” Goodwin said. Riley agreed, saying Medicaid expansion helps keep rural hospitals open.

“We have over a million uninsured people,” Riley said. “If we are not expanding Medicaid, we’re not going to be able to manage health and improve health outlooks here in North Carolina.”

Said Dollar, “If you do the Working Families Program that the Republicans are talking about in the North Carolina House, that will help hospitals, but to say that it would magically stem [health care consolidation] is not necessarily true.”

Loretta Boniti, senior political reporter at Spectrum News, moderated the debate. An edited version will be broadcast 11:30 a.m. Sunday, Sept. 29, on Spectrum. The full-length debate will available online at

Beginning in 2016, the IOPL Hometown Debate Series features state lawmakers and policy experts discussing issues of state public policy. Series topics in previous years included proposed constitutional amendments and education policy. The following three health care policy debates of the 2019 series are open to the public. Topics and locations are as follows:

• Health Insurance Access, Affordability, and Cost, Oct. 1, at the Norvell Theatre in Salisbury.

• Access to Healthcare in Rural Areas, Oct. 8, at the Black Box Theatre at East Carolina University in Greenville.

• Delivery of Medical Services, Oct. 17, at the Vance-Granville Community College Civic Center in Henderson

Series sponsors for 2019 include the N.C. Association of Health Underwriters, Independent Insurance Agents of N.C., Blue Cross Blue Shield of North Carolina, the N.C. Rural Center, and Humana.

Established in 1988, the N.C. Institute of Political Leadership is a nonpartisan organization, specializing in leadership training programs for public servants.