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N.C. Medicaid expansion unlikely following Supreme Court ruling

By Josh Bergeron

josh.bergeron@salisburypost.com

North Carolina residents should not expect an expansion of Medicaid following Thursday’s U.S. Supreme Court decision to uphold federal tax subsidies created by the Affordable Care Act, according to local legislators.

In a 6-3 ruling, the court upheld the ability for North Carolinians and residents of 33 other states to receive tax subsidies. The case specifically focused on whether residents of states without a state-based exchange, such as North Carolina, could receive the subsidies to pay for insurance. About 460,000 North Carolina residents risked losing tax credits and seeing premiums increase if the Supreme Court hadn’t upheld the subsidies.

Justices Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan, Anthony Kennedy, Sonia Sotomayor and Chief Justic John Roberts favored upholding the subsidies.

“Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” Roberts wrote in the court’s opinion.

Justices Antonin Scalia, Samuel Alito Jr. and Clarence Thomas dissented.

Gov. Pat McCrory earlier this year said he would wait until after the Supreme Court’s ruling to recommend an expansion of Medicaid with help from the Affordable Care Act. McCrory on Thursday said more questions remain about whether the state should expand Medicaid.

An expansion would require the approval of North Carolina’s General Assembly, which do not appear ready to seriously consider an expansion. Two opposite Medicaid overhauls are contained in the House and Senate budgets. Both are aimed at cutting costs, which Rowan’s representatives say are growing too quickly.

“You get more federal money for a brief period of time, and then you’re on your own,” said state Rep. Carl Ford, R-76, about a Medicaid expansion. “Medicaid has already expanded itself to the tune of $2 billion. We don’t need to go any further. We’re having difficulty paying for it now.”

The method of administration — currently being discussed by the legislature — must be determined before Medicaid expansion can be discussed, said state Rep. Harry Warren, R-77. The state Senate’s budget, for example, sets up a new organization to oversee Medicaid. Medicaid would be managed mostly by for-profit organizations, under the Senate’s plan. The House seeks to allow non-profit groups of hospitals and doctors to manage care.

“The ruling doesn’t change anything other than validating the way the system has been running,” Warren said. “It wouldn’t have an impact on whether or not to expand Medicaid. Cost control is the first consideration in deciding whether or not it can expand.”

Cost was also a premise behind most of Rowan County’s members of Congress, who immediately issued criticism of the Supreme Court’s decision.

U.S. Rep. Virginia Foxx, a Republican who represents the 5th District, said she’s received numerous complaints from constituents about cancelled health insurance plans, soaring premiums and increased deductibles.

“Despite its central promise, the Affordable Care Act has proved to be anything but affordable for many North Carolinians, and today’s Supreme Court decision doesn’t change that fact,” Foxx said. “Rather than making piecemeal fixes, the best approach to solving the multitude of problems resulting from Obamacare is to unite behind a complete repeal of the law and replace it with solutions that lower costs and empower patients to choose the care that’s right for them.”

Some, including U.S. Rep. Richard Hudson, a Republican who represents the 8th district, said they remain committed to repealing the Affordable Care Act, even with the court’s decision.

U.S. Sen. Thom Tillis called the Affordable Care Act fundamentally flawed and beyond repair.

“I remain committed to finding and implementing a solution,” Tillis said. Both parties need to come together to fix our broken health care system once and for all by making it more affordable, accountable, and patient focused, and giving families more freedom and choice when it comes to making decisions that work best for them.”

U.S. Rep. Alma Adams, D-12, was Rowan County’s lone lawmaker — in Congress or the General Assembly — who called the ruling a victory for residents of North Carolina.

“For purely political reasons, North Carolina chose not to create a state exchange; but that hasn’t stopped ACA from helping hundreds of thousands of North Carolinians get the healthcare they need and deserve,” Adams said. “Today’s Supreme Court decision is a victory for more than 407,000 North Carolinians who receive subsidies with their federal marketplace plans. I’ll remain unwavering in my support for this law that has helped close the coverage gap for millions of Americans across the United States.”

Contact reporter Josh Bergeron at 704-797-4246.

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