This morning was the first meeting of the North Carolina Council for Health Care Coverage, set up by North Carolina Governor Roy Cooper. The council is comprised of North Carolina legislators from both sides of the aisle, researchers from North Carolina educational institutions, and private sector stakeholders.

Here is how Governor Cooper described the motivation behind setting up the council in an interview with the AP, “I think that there are core principles that we can agree to, like the fact that more people in North Carolina deserve health insurance. This is not just purely a Medicaid expansion issue.” I was discouraged to find out that every presentation in this first council meeting dealt solely with Medicaid expansion.

The council heard from different presenters from Duke, UNC, NC Medicaid, and a former Director of the Ohio Governor’s Office of Health Transformation. The presentations focused on data concerning the Medicaid population, the Medicaid “coverage gap,” rural health care, and Ohio’s Medicaid expansion. There were questions about a possible discussion of health care reform that does not involve Medicaid expansion, but the hosts said those discussions would happen at future meetings.

While its supporters parrot Medicaid expansion as only providing positive consequences, there are also negative consequences and opportunity costs of such a policy. As usual, those considerations were left out of today’s discussion.

Here are some Medicaid expansion points that weren’t discussed today:

  • States are responsible for 10 percent of the total share of Medicaid expansion costs, no matter how many people sign up or the cost of each enrollee. Governor Cooper and expansion advocates have claimed the 10 percent state share will be covered by taxes on hospitals and health insurance plans. According to a recent WFAE article by Dana Ervin, the North Carolina Hospital Association hasn’t committed to covering the cost through a self-imposed tax. Furthermore, this provider tax is a sleight of hand to draw down more federal money.
  • Even if the hospitals and health insurance plans agree to the tax, it may not be enough to cover the 10 percent. A recent analysis by the John Locke Foundation found that there could be a funding gap of anywhere between $119-$171 million each year even with the tax on hospitals and insurers. 
  • The importance of getting coverage for the uninsured was highlighted in the meeting. According to data from the Kaiser Family Foundation, 40 percent of North Carolina’s uninsured (338,200!) are currently eligible for a free Bronze plan on the ACA after subsidies.
  • Rural hospitals were also discussed in the context of expanding Medicaid. According to a report by the Foundation for Government Accountability, Medicaid expansion is not a silver bullet for rural hospitals and the complex issue of rural health. The report found that after expansion, hospitals haven’t seen financials materially changed, non-expansion states had higher hospital job growth than states that had expanded Medicaid, and hospitals are still closing in states that have expanded Medicaid.

Opponents of Medicaid expansion are often framed as not caring for those who don’t have health coverage, racist, or not having ideas for creating opportunities for increased coverage. This couldn’t be further from the truth. Like myself, opponents of Medicaid expansion believe there are better ways to achieve the same ends as those who support Medicaid expansion.

Here are two reforms where health care coverage can be expanded at more affordable rates than the current insurance products:

Here are a few reforms which would lower the cost of accessing health care:

This task force has the potential to advance the discussion on health care reform in North Carolina. I look forward to future meetings and future discussions about expanding coverage and access while reducing costs with the goal of a more functional health care system.