Work exemption may mean Medicaid expansion

Editorial by Fayetteville Observer, January 16, 2018.

It was a surprising to see last week that North Carolina is one of the state’s seeking a federal exemption that would allow it to require employment in return for Medicaid eligibility. That’s not the sort of request we’d expect from a Democratic governor. But there it was: North Carolina joined nine other states in requesting an exemption from Medicaid rules that forbid imposing a work requirement.

The leader of that pack was Kentucky Republican Gov. Matt Bevin, who ousted the state’s Democratic governor in 2016 with a campaign that, among other things, opposed Obamacare. But Bevin hasn’t gotten rid of the remarkably successful expansion of Medicaid that was funded by the Affordable Care Act. The expansion cut the state’s uninsured rate from more than 20 percent down to 9 percent. It created about 12,000 jobs in the health care industry and helped save many of the state’s financially troubled small, rural hospitals. The program is extremely popular among Kentucky residents, so Bevin hasn’t moved to end it. Rather, he’s trying to institute more cost controls and limit its further growth by, among other things, require able-bodied recipients to work.

Advocates of expanded Medicaid believed we would see the same benefits that helped Kentucky. The Affordable Care Act covered almost all of the expenses of the expansion’s startup and would permanently fund more than 90 percent of the program’s costs. But Republicans staunchly fought anything connected with Obamacare. The expansion never happened.

But here’s the thing that seems puzzling at first: The work requirement exemption that Gov. Roy Cooper has requested is unlikely to affect any current Medicaid recipients in North Carolina. The only people who could be put to work are people 18 to 64 whose health is good enough that they can hold a job. Their incomes would need to be below 133 percent of federal poverty level — the “working poor.” In North Carolina today, few people in that group have insurance coverage, because they are too poor to qualify for policy subsidy through the Affordable Care Act but don’t qualify for the existing Medicaid program either. They are the people who use free health-care clinics or who show up at the state’s emergency rooms for basic health care services — where they can’t be turned away. The hospitals, and the rest of their paying patients, end up subsidizing the “free” care.

They would qualify for Medicaid insurance if North Carolina had expanded the existing Medicaid program, and they would qualify if the state had enacted last year’s House Bill 662, which would have created the Carolina Cares Program. The bill’s primary sponsors are Republican lawmakers, but a group of Democrats — including Rep. Marvin Lucas of Spring Lake — has signed on as co-sponsors.

The bill was filed last April and passed on its first reading, but it was headed toward death on a committee shelf as Congress and the president appeared poised to repeal Obamacare, and with it, subsidies for an expanded Medicaid program. But things have changed since then. The repeal didn’t happen, although the administration has seriously weakened the program and the insurance exchanges that were at its core. But in those states that expanded Medicaid, the program is till running and still getting federal funding. Given the numbers of Republican-led states with expanded Medicaid programs, it’s reasonable to expect that the supplementary Medicaid program isn’t going away anytime soon.

Under Carolina Cares, recipients would need to pay small premiums and a co-pay for medical services. The bill has a work requirement.

House Bill 662 and the Carolina Cares Program may be just what the governor had in mind when he applied for that Medicaid work-requirement exemption.

When the General Assembly goes back into regular session this spring, we hope the leadership will give new life to House Bill 662. Even with a work requirement, premiums and co-pays, it’s a lot better than what the working poor have available to them today, and a whole lot better for our economy.

http://www.fayobserver.com/opinion/20180116/our-view-work-exemption-may-mean-medicaid-expansion