By Taylor Sisk
On their first day back in session, North Carolina Senate Republicans introduced a bill yesterday to opt out of several provisions of the federal Affordable Care Act, or Obamacare, scheduled to go into effect next year.
Senate Bill 4, introduced by senators Tom Apodaca (R-Henderson), Harry Brown (R-Onslow) and Bob Rucho (R-Mecklenburg), would exempt the state from establishing a state-run health insurance exchange or a federal-state partnership exchange. The bill would also rule out expansion of the state’s Medicaid program.
In addition, the bill directs the state Department of Insurance to return unspent grant funding provided earlier this month by the federal government to create a federal-state partnership exchange.
“We feel that it is in the best interest of the state of North Carolina for us to act in this manner,” Rucho said.
Republicans in the state House of Representatives later introduced a similar bill.
“Senate Republicans are committed to ensuring every North Carolinian receives the highest quality health care and outcomes,” Senate President Pro Tempore Phil Berger (R-Rockingham) said in a press release. “Saddling our citizens with the enormous costs of a new federal bureaucracy and entitlements is simply not the way to achieve this goal.”
The Affordable Care Act (ACA) stipulates that each state must offer a health-care exchange, or marketplace, in which individuals and small businesses can purchase health-care coverage. States may opt for a federally run exchange, a state-run exchange or a federal-state partnership, whereby federal planners create and run the exchange but states run the consumer support portion of the program.
Under Senate Bill 4, the exchange would be federally run.
“We just have elected not to participate as a state, and our caucus is behind this,” Apodaca said. “We don’t feel like we should bind the people of North Carolina to the ACA, and so we are opting out of it, and if the feds want to do it, let them.”
Last summer the U.S. Supreme Court upheld the ACA but ruled that the expansion of state Medicaid programs included in the law was optional, leaving it up to individual states to decide whether or not to go forward with the expansion. Those that chose to expand Medicaid will receive additional federal funding.
Senate Minority Whip Josh Stein (D-Wake) expressed particular concern at the decision not to expand Medicaid, stating that over a 10-year period more than $15 billion in federal support that would go to North Carolina communities, particularly rural communities, would be lost.
“These dollars go to doctors, hospitals, physical therapists – these are critical services, and will benefit a half a million North Carolinians,” Stein said.
“I think to introduce legislation to opt out of Medicaid expansion is very concerning,” Stein continued. “I certainly will hope that we have extensive deliberations and that the majority party is willing to listen to ideas from the minority.”
‘Let them do it’
Last November, then-Gov. Beverly Perdue announced that the state would establish a federal-state partnership exchange. Two weeks ago the U.S. Department of Health and Human Services awarded the state a $73.9 million grant to set up the hybrid exchange.
But Apodaca said on Wednesday that he felt this was a decision for the legislature to make. “That’s what we’re doing,” he said of the introduction of the bill, “exercising our authority.”
Apodaca said he doesn’t feel that passage of the bill would mean the state would be surrendering any control to the federal government.
“You’re never going to have local control,” he said, “that’s just a farce, because the feds are going to dictate what you have.”
“Ultimately, the feds are going to have the authority, regardless,” he added. “So if they’re going to have the authority, let them do it.”
Currently, North Carolina has about 1.5 million uninsured residents. According to the North Carolina Institute of Medicine, close to 600,000 low-income people who are currently uninsured would be eligible for coverage under Medicaid expansion.
It’s estimated that the expansion would cost North Carolina some $850 million over the first six years of implementation but would also bring to the state approximately $16 billion in federal money.
A recent analysis by the Urban Institute calculated that by expanding, North Carolina could end up saving state dollars, as the state would pay less to subsidize hospitals that care for people who are uninsured.