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NC Justice Center, Taking action on immigrant detention.

Update June 28: Gov. Cooper has vetoed the budget! Scroll down to see what this means and WHAT YOU CAN DO NOW to support his veto and support Medicaid expansion!

With the budget deadline of June 30 looming, the tug of war between Gov. Cooper and the Republican leadership in Raleigh around Medicaid expansion is ramping up. Sen. Berger and Rep. Moore are spreading the usual misinformation - it would be a "disincentive to work" says Berger, Moore says, "the best thing that folks can do is get a job." A familiar trope that ignores the many thousands of low-income and working people (self-employed, multiple part-time jobs, jobs without benefits) who fall in the coverage gap between current Medicaid and qualifying for an ACA subsidy on the marketplace.

More inconvenient (for them) facts: "A new report released this morning (June 26) finds that expanding Medicaid in North Carolina would create more than 37,000 new jobs and insure approximately 365,000 more people. The report was prepared by researchers at The George Washington University with funding from Cone Health Foundation and the Kate B. Reynolds Charitable Trust. In addition to the new jobs created and the hundreds of thousands of uninsured residents gaining coverage, the researchers estimate that the state would increase its business activity by $11.7 billion in just three years, between 2020-2022. It’s money that could be spent on education, infrastructure and other needs." From NC Policy Watch; direct link to the report.

Cooper issued a memo on June 20 expressing his support for a two-track negotiating process for the 2019-20 state budget, with one negotiating track focused on health care issues, including Medicaid expansion, with state health Secretary Dr. Mandy Cohen in charge. The other track would be “on the larger budget framework.” There's been no specific response to that approach as best I can tell from searching the interweb. Senate budget chairs issued a letter after a meeting last week with Gov. Cooper in which they outlined their continued objection to Medicaid expansion, saying that one item should not hold up the entire budget.

Then on Tues, June 25, with the House/Senate compromise budget nearing final approval (WITHOUT Medicaid expansion), language appeared in the budget saying “the General Assembly encourages the Governor to convene an extra session” to “consider access to health care across North Carolina.” The N&O also reports that "Senate leader Phil Berger said they’d be open to having a Medicaid expansion debate later this year after the budget talks are done, although he didn’t make any promises that it would pass." Right... They are in session NOW and could deal with it NOW. Postponing it to a special session eliminates the major budget veto leverage Cooper has now. The governor was elected by 2,309,157 NC voters with a clear platform supporting Medicaid expansion. How many voters elected Sen Berger and Speaker Moore, the major obstacles to Medicaid expansion? 43,132 and 16,511, respectively. You do the math.

Gov. Cooper has not stated that he will definitely veto the budget if it doesn't include Medicaid expansion, though it's expected that he will - and that his veto would be upheld. NC budget has veto written all over it. Cooper has scheduled a press conference at the Governor's Mansion on Friday morning, after the budget has passed both chambers, perhaps signaling his intention to veto.

What would happen if this tug of war extends well into the new fiscal year, which starts on July 1? It won’t resemble a federal-style government shutdown. Existing law will allow state government to enter its 2019-20 fiscal year on July 1 under spending levels previously enacted for 2018-19. Core state government services will continue, but the clock will start to tick for some agencies/organizations that depend on appropriations that end specifically on June 30, 2019. This battle could continue for months. Dear NC lawmakers, can the budget theatrics.

Instead of addressing the unmet health needs of North Carolinians, the Republicans in the Senate instead suspended its rules to introduce a new health care bill last week, SB681, Rural Health Care Stabilization Act. This would create a state-funded (aka, tax-payer-funded) loan program for rural hospitals that are struggling because we haven't expanded Medicaid. This addresses the symptom, not the cause, of financial strain on rural hospitals, which is the uncompensated care they provide to uninsured residents. It’s incomprehensible why this is a preferable option to expanding Medicaid, which would leverage federal funding to reduce uncompensated care at all hospitals.

On the other side of the building, the House is expected to move SB86, Small Business Health Care Act, which includes authorizing Association Health Plans, but not any version of Medicaid expansion. From NC Justice Center: "These plans can avoid rules governing small group and individual market coverage, enabling them to siphon off lower-risk enrollees from the regular small group and individual markets. But any reduction in premiums that SB 86 may offer to some small businesses and individuals come only at the expense of others who would have to pay higher costs. Association Health Plans’ promise of lower premiums rests on skirting consumer protections and cherry picking enrollees via benefit design and premium practices."

There also are rumors of the House introducing an omnibus health care bill that would wrap together several individual bills that have already been introduced, again without including Medicaid expansion.

Anything to avoid doing what makes the most sense, financially and morally: EXPANDING MEDICAID NOW. More resources on this issue:

  • Video coverage of NC's state-wide vigils from the NYT, I'm Republican, I never thought I'd fight for Medicaid.
  • Overview and comparison of House & Senate versions of the Health & Human Services budget from NC Health News.
  • Busting four key myths behind "cruel and thoughtless" Berger-Moore Medicaid blockade from NC Policy Watch and WRAL.
  • From Gov. Cooper's office, Myths vs facts on Medicaid expansion.
  • Library of fact sheets and reports from the NC Justice Center, filter for Medicaid and Health & Human Services.

What you can do

  • Contact your NC legislators using this link from the NC Budget & Tax Center.
  • Share the NYT video widely with the hashtags #ncpol and #closethegapnc.
  • Here's a link to share it on Facebook and here's one for Twitter.
  • Tweet the video link to your NC legislators, @senatorberger and @nchousespeaker.
  • Search for and retweet posts from #closethegapnc.
  • In addition to using social media, call or email your NC legislators to let them know you support expanding Medicaid NOW.
    • Do this if you're represented by Republicans. There are Republicans who are open to Medicaid expansion, but being pressured by their leaders to fall in line. Hearing from constituents could help move them to do the right thing for their districts NOW, not waiting for a special session during which the outcome is doubtful, especially in the Senate. Democratic Senators voting with the Republicans to approve the second reading of the budget included Clark, D Davis, Fitch, and McKissick. If they represent you, urge them to uphold the governor's veto.
    • Do this if you're represented by Democrats because Republicans are dangling local budget carrots in front of Democrats who might be swayed to override a veto from the governor. Democrats voting with the Republicans to approve the second reading of the budget included Brockman, Floyd and Hunter. If they represent you, urge them to uphold the governor's veto.
  • Contact Gov. Cooper, 919-814-2000, to express support for his veto of a budget without Medicaid expansion. Tweet him at @nc_governor.
  • Share and attend these events:



Tags: (Medicaid Expansion, Healthcare, NCGA, NCPol)

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