Republican Gov. Pat McCrory has had numerous battles with Democrats during his first year in office, and Monday was no different. In a call arranged with the help of the White House, state Democrats spoke out angrily against his decision not to expand Medicaid.
"I know Gov. McCrory. I know he's a caring individual, but I think he's gone too far to the right on this," said Bill Bell, the Democratic mayor of Durham, during the call with reporters.
The call was one of several arranged by the White House press office, with representatives from states where Medicaid expansion has been rejected, in an effort to drum up support for the program.
About 61,000 residents in Durham, a small city just outside of the capital of Raleigh, would have been eligible for Medicaid if the governor had allowed the expansion, says Bell. Instead, as a result of McCrory's decision, Democrats estimate these residents will be a part of the nearly 377,000 state residents who will not receive the benefits.
"Our residents are missing out on an opportunity here." Not only will fewer people have access to health insurance, but tax dollars from North Carolina will benefit Medicaid plans in other states, making North Carolina "a donor state," he says.
A recent report from The Common Wealth Fund, a think tank that conducts research on health care issues, says North Carolina could lose $2.5 billion by declining Medicaid expansion.
State Sen. Floyd McKissick, a Democrat whose district includes Durham, says by turning down Medicaid expansion the governor is turning down jobs. The $6 billion the state would have received during a three-year period if it had expanded Medicaid could generate roughly 20,000 jobs, according to McKissick. McKissick noted North Carolina has one of the top five unemployment rates in the country. The governor was elected after a campaign that stressed job creation.
The problem of not receiving the increased Medicaid funding is compounded by reductions in the Medicaid Disproportionate Share Hospital payments, says McKissick. (The Kaiser Family Foundation explains the precise changes to DSH payments under Obamacare.)
When the Supreme Court ruled on the constitutionality of Obamacare, it upheld the individual mandate and left Medicaid expansion intact, but limited the power of the federal government to enforce it, giving states the choice of whether to expand Medicaid. For states that have chosen to expand Medicaid, the income level at which people would be eligible for federal and state funded health insurance rose to between 133 percent and 138 percent of the poverty level (depending on the state). This is about $32,000 for a four-person household, up from about $24,000 for 2014. Raising this limit would allow 377,000 more North Carolinians to obtain health insurance by 2016, according to a White House press statement. The federal government would cover 100 percent of the cost of expansion through 2016, and 90 percent of the cost through 2020, says White House spokesman Josh Earnest.
"There are a lot of people who are going to fall in this loophole, where they're not going to qualify for the subsidies of Obamacare but they would have been covered under Medicaid if it had been expanded," says Dora Gicheva, assistant professor of Economics at the University of North Carolina, Greensboro.
In March 2013, McCrory signed a bill preventing the federal government from expanding Medicaid, The Charlotte Observer reported. McCrory argued the state's Medicaid system was dysfunctional.
"Before I expand the system, I've got to fix the current system," McCrory said in an MSNBC interview shortly before rejecting the health plan.
A representative from the governor's office said his position has not changed since October, when he refused to hold a special session to expand Obamacare. "I will not sacrifice quality care for the people truly in need, nor risk further budget overruns by expanding an already broken system," McCrory said in a press release dated Oct. 28.