Pete Kaliner

Pete Kaliner

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Medicaid expansion blows up another state budget

For years, North Carolina politicians and their allies in the media have treated opposition to Medicaid expansion as rooted mainly in hatred of the poor. The various arguments offered by opponents are often dismissed as unrealistic when not simply ignored.

So, while I'd like to think the news out of New York would humble some of the expansionists (or at least prompt a re-examination), I am not confident it will...

This year will be the biggest budget challenge for Gov. Andrew Cuomo since he took office in 2011.
Exploding costs in New York’s popular health-insurance program for the needy is largely fueling the state’s projected $6 billion budget deficit for 2020, and Cuomo is already so worried about getting it under control that he didn’t even wait for his State of the Speech on Wednesday to take action.

Opponents have been warning of the fiscal damage done to state budgets when Medicaid is expanded to cover able-bodied, working age adults -- a population never intended for coverage under the program.

New York is the latest to discover the obvious. Governor Cuomo tried to hide the true costs, but there's no hiding now:

During his first year as governor in 2011, Cuomo and legislators took actions to close a $10 billion hole that included cuts to education and other programs and imposed a spending cap, including on Medicaid. The crisis came as the state was still recovering economically from the recession.
Cuomo was praised by budget watchdogs for controlling spending at the time. But he has come under criticism since then for masking the increased Medicaid costs by delaying payments from one fiscal year to the next, including pushing $1.7 billion in costs from last year’s budget to the current one.
The maneuver “made it appear that the [Medicaid] program was staying on budget when, in fact, it was slipping increasingly out of balance,” said Bill Hammond, who tracks health-care financing for the nonpartisan Empire Center for Public Policy.

Another warning from opponents of expansion is that once you put health care into a government budget, it becomes subject to the pressures and whims of politicians. Once GovCo takes over and makes people dependent on the program, it can cut that spending. Which is what New York is doing:

He invoked an emergency order last week calling for a 1 percent reduction in payments to hospitals, nursing homes, doctors and pharmacists who participate in the state’s Medicaid program.
The cuts will save $620.4 million through the state’s next fiscal year, or April 1, 2020, to March 31, 2021, the state Health Department said in the order.
But that’s just a drop in the bucket compared to what the state will be in debt for during the same period.

North Carolina Governor Roy Cooper has chosen Medicaid expansion as the hill to die on. It's why we have the budget stalemate. He has repeatedly said expansion would create jobs and lead to more revenue for state government.

Perhaps someone could ask him about New York's experience. Maybe at his next fundraiser up there?

Pete's Prep: Tuesday, Jan. 7, 2020

Asheville Citizen-Times: "The controversial, 802-unit Crossroads at West Asheville apartment complex proposal has been pulled, meaning the project is "basically dead.""

News & Observer: "Members of the State Board of Elections admonished county election board members to “get off Facebook” and “delete your Twitter account,” as they reviewed the latest complaints of improper social media posts by local election officials."

John Locke Foundation: "When did [Gov. Roy] Cooper change his mind about making consumers pay for coal-ash cleanup? Why?"

WRAL: Gov. Roy Cooper made 31 promises since his campaign for Governor, but has only achieved 7 of them. (This is promise tracker is not to be confused with the abandoned "Coop-o-meter" by PolitiFact.)

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