- Associated Press - Friday, February 20, 2015

RALEIGH, N.C. (AP) - Gov. Pat McCrory says his decision to wait longer to announce whether he’ll seek to cover hundreds of thousands of uninsured North Carolina residents through the federal health care law doesn’t mean he’s putting the idea on the back burner.

The Republican governor said this week he wouldn’t weigh in with the legislature until after a U.S. Supreme Court ruling on a key element of the 2011 law - potentially delaying the issue for another year because the General Assembly session will be near its end by then. Oral arguments are scheduled in early March, with a ruling unlikely until early summer.

“The court case has major ramifications on the entire health care system,” McCrory told The Associated Press in an interview in which he confirmed the delay. In the meantime, the governor added, he’ll keep reviewing potential expansion plans.

But the legal fight in Washington provides an out for McCrory to keep expansion from gumming up the debate in Raleigh on something more important to his administration. He wants changed this year the current financial mechanism for treating patients within North Carolina’s $13 billion Medicaid system.

House and Senate leaders came close last summer to agreeing to create a system in which medical organizations ultimately would get a flat per-month amount to cover the treatment of each of the 1.8 million Medicaid enrollees they see. McCrory believes the change would help avoid future Medicaid shortfalls and make patients healthier.

“I’ve always said I’ve got to fix the current Medicaid (system) to help the women, children and disabled and elderly who are currently served by Medicaid before we expand it,” McCrory said after speaking to the North Carolina Hospital Association in Cary.

The delay also means the governor avoids a showdown with fellow Republican leaders at the General Assembly strongly opposed to expansion, especially if it increases Medicaid rolls substantially. Budget-writers have suggested revisiting the idea after the Supreme Court decision is handed down.

“Expansion was never part of the conversation about (Medicaid) reform in the legislature,” said Sen. Ralph Hise, R-Mitchell, a budget subcommittee co-chairman on health matters, adding the delay is “a good step for the governor.”

Expansion proponents see the Supreme Court case as a weak excuse for McCrory to kick the can down the road for people who make too much money to qualify for Medicaid but not enough to receive tax credits for premiums. The state NAACP chapter and allies have repeatedly demanded expansion and argue not doing so violates the state Constitution.

“Either he’s committed to it or he’s not committed to it,” Sen. Gladys Robinson, D-Guilford, a health budget subcommittee member, said Thursday. “I think he has an obligation to the citizens of North Carolina who are not the wealthy people, but the people who need health care.”

A December study written for two health foundations estimates 478,000 people would enroll in Medicaid in North Carolina by 2017 if it were approved this year and create 43,000 jobs. The federal government would pay for at least 90 percent of the costs of expansion over time.

McCrory says he’s looking closely at ways to expand coverage without necessarily increasing Medicaid rolls. The governor has met this year with President Barack Obama and U.S. Health and Human Services Sylvia Matthews Burwell on the topic.

During his State of the State address Feb. 4, McCrory said any plan “must protect North Carolina taxpayers. And any plan must require personal and financial responsibility for those who would be covered.”

The few states that have received federal government waivers to operate alternate plans require recipient co-pays or small monthly premiums. Work requirements have been rejected, according to the Kaiser Family Foundation. McCrory said the Obama administration needs to show more flexibility.

Hise said: “You’ve not seen a plan that would fit a philosophy that would be acceptable to most conservatives.”


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