Duke University Health Policy Expert: The Case Against Medicaid Expansion in North Carolina
Article knocks down arguments about Medicaid expansion that Democrats continue to use today
Raleigh, N.C. – Earlier this week, Democrats continued their efforts to expand Medicaid in North Carolina, holding a hearing on the topic at the legislature. In light of that renewed push, it’s worth revisiting an article published in the North Carolina Medical Journal in 2017. Christopher Conover, a Research Scholar in the Center for Health Policy & Inequalities Research at Duke University, outlined a number of reasons why Medicaid Expansion is not a good idea for North Carolina that directly rebut some of the benefits being touted by Democrats. .
1) Medicaid Expansion Will Reduce Access for Existing Medicaid RecipientsConover explains that due to Medicaid’s low reimbursement rates, many Medicaid enrollees already have difficulty locating a provider, an issue that expanding Medicaid would only exacerbate:
” A model developed by the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill showed that, in the year 2020 alone, Medicaid expansion would increase the unmet demand for physician services by over 25%. In the context of this physician shortage, it makes little sense on ethical or clinical grounds to divert care away from existing Medicaid beneficiaries, who are among our most vulnerable populations—elderly individuals, persons with disabilities, pregnant women, infants, and children. “
2) Medicaid Expansion is Unlikely to Save LivesConover points out that there is no concrete evidence to back up the argument that expanding Medicaid will save lives:
“The best available evidence regarding Medicaid’s actual impact on health and mortality risk comes from the Oregon Health Study, which is as close to a randomized controlled trial as we might ever get on this question. In that study, Medicaid ‘generated no significant improvement in measured physical health outcomes,’ nor did it result in a statistically significant reduction in mortality risk.”
3) Medicaid Expansion is Unaffordable in the Long RunConover makes the point that it is extremely unlikely the federal government will continue to fund Medicaid expansion at the current levels, especially considering the fact that enrollment levels and the cost of expansion have been much higher than predicted:
The most recent annual report on Medicaid’s finances issued by the US Department of Health and Human Services (HHS) showed that the average cost of the ACA’s Medicaid expansion enrollees was nearly 50% higher in FY 2015 than HHS had projected just 1 year previously. Additionally, enrollment exceeded projections in states that elected to expand Medicaid by 110% nationally, and this problem has been much more severe in some states. Expansion enrollment exceeded projections by 322% in California, by 276% in New York, and by 134% in Kentucky. “
4) Medicaid Expansion will Eliminate More Jobs than it CreatesClaims that expanding Medicaid will bring thousands of new health care jobs to North Carolina is one of the benefits of expansion that supporters continue to mention, but Conover points out that these jobs come at a cost:
“The RAND Corporation has shown that every new job added to the health care sector results in 0.85 fewer jobs in the rest of the economy. Even worse is that every $1 raised in taxes shrinks the economy by 44 cents. This implies we would lose 144 jobs for every 100 health sector–related jobs that might be induced by expansion. In the end, then, Medicaid expansion is not merely a break-even proposition that shifts jobs from the general economy into the health sector: it actually reduces total employment in the economy overall.”

Our booth at the Madison County Fair had and awesome response and even more surprisingly the Madison County democrats were M.I.A.

We are having a great response and selling raffle tickets for a brand new Ruger .308 ($5 each or 5 tickets for $20). We will draw a winner in time for Christmas!!


President Pro Tempore

Senator Phil Berger

Contact: Senator Berger Press

August 21, 2019
Legislative Leaders Announce $250 Taxpayer Refund

Berger, Moore: N.C. taxpayers sent us too much money, so we’re giving it back

The people spend their money better than government spends their money
Raleigh, N.C. – Senate Leader Phil Berger (R-Rockingham) and House Speaker Tim Moore (R-Cleveland) today announced the Taxpayer Refund Act. If passed into law, every taxpayer would receive a refund in the amount they paid in state taxes, up to a maximum of $125 for an individual or $250 for a couple.

Senator Berger said, “Tax revenues don’t belong to the government, they belong to the people who earned it. Refunding up to $250 means a lot to a family that’s living paycheck-to-paycheck. We collected more money than was needed, so we’re giving it back.”

Speaker Moore said, “Sending taxpayer relief back home to hardworking North Carolinians is consistent with the General Assembly’s successful approach to the state budget that built the $900 million surplus and benefits families with higher take-home pay, more jobs, and a rapidly growing economy.”

Andy Ellen, President of the N.C. Retail Merchants Association, said, “An infusion of $650 million into North Carolina’s economy would certainly be a welcome shot in the arm for North Carolina’s Retail Industry especially as we head into the fourth quarter of the year and the very important holiday season.”

Fast Facts:

Cost: There is no “cost” because this bill is returning money to the people who earned it. In that sense, the refund will return $663 million to the people.

Recipients: More than 5.1 million taxpayers would receive a refund. More than 90 percent of taxpayers would receive the maximum refund. More than 350,000 taxpayers would have their entire tax liability covered by the refund.

Mechanism : The North Carolina Department of Revenue will send a check to every taxpayer equal to the amount that person or couple paid in state taxes, up to $125 for an individual or $250 for a couple.

Timeline: The Taxpayer Refund Act instructs the Department of Revenue to issue checks as soon as possible. The Department must mail checks by December 15, 2019 for those who filed before August 1, 2019. The Department must mail checks by February 1, 2020 for those who filed between August 1, 2019 and October 1, 2019.

Impact on the Budget: There is funding available to both refund the surplus to taxpayers and enact a new budget at higher spending levels.

Legislators continue to be willing to negotiate with Governor Cooper about the budget, but he maintains his refusal to sign any negotiated budget into law unless the legislature first passes Medicaid expansion. Instead of sitting on a pile of cash, legislators intend to return this money back to the people who earned it.

Liberal Democratic interest groups will likely say the people’s surplus should be spent by government. Here’s a brief list of priorities that were already included in the budget that Governor Cooper vetoed, and could be passed into law if Governor Cooper would drop his Medicaid-or-nothing ultimatum:

Public education: $1.43 billion increase over two yearsSchool construction and repairs: $4.4 billion over 10 yearsTeacher salaries: 3.9% raise over two years (not including bonuses)State employee salaries: 5% raise over two yearsSewer/water infrastructure: $19.5 million to a brand new Rural Infrastructure Fund

Senator Harry Brown (R-Onslow) said, “The idea that this surplus should be spent on other priorities is just ridiculous. There are already spending increases in just about every area, and Democrats are blocking them over a single policy disagreement.”
North Carolina General Assembly
Senator Ralph Hise
Contact: Susan Fanning
August 7, 2019
Sen. Hise Issues Statement in Response to Governor Cooper’s
Appointment to State Board of Elections
Raleigh, N.C. – Earlier today Governor Roy Cooper appointed Damon Circosta to the State Board of Elections as a Democrat. Circosta previously served as the unaffiliated member on a previous iteration of the board. Sen. Ralph Hise (R-Mitchell) issued the following statement in response to the Governor’s appointment:“Governor Cooper isn’t even pretending that he cares about good government. By appointing Damon Circosta to the Board today as the tie-breaking Democrat, he’s admitting that his previous appointment of Circosta as an ‘unaffiliated’ member was a sham. “Instead of injecting stability to the Board by appointing somebody all parties respect, Governor Cooper yet again chose power politics over legitimacy and fairness. “If this is Cooper’s idea of an independent body, just imagine what a cesspool an independent redistricting committee would turn into. To paraphrase the Governor’s own statement from last year, ‘it’s unbelievable to watch Democrats try to rig the rules of a system they’ve already gamed.’”

Why the Budget fight is Important 

The North Carolina House of Representatives gave final approval to a $24 billion budget on June 27th. The Governor vetoed the bill the following day June 28th.

We have been dealing with this veto ever since. While the Members are still in session hearing bills and attending committee meetings, the budget is the main focus and we are at an Impasse!

To recap – The Governor rejected the budget for the following reasons: the funding method for school construction and repair, it did not allocate enough funding for teacher pay raises, and it did not expand Medicaid. Rarely have we seen a Governor place specific demands on the budget process and further, stating that he will not sign a budget without his demands prior to the budget even being presented and released.

There are truly philosophical differences in the Governor’s proposals and that of the General Assembly Republicans and some Democrat leaders.

Here are the differences in the three major demands the Governor put forward: (1) the Governor wants to fund school construction and repair with a multimillion dollar bond. His original bond amount exceeded our debt capacity by $2 billion. The General Assembly wants to pay for school construction and repair with “real cash money”, and lots of it. The funding is available in “real cash” from the State Capital Infrastructure Fund; (2) the Governor wants 9% pay increase for teachers. The General Assembly recommended 3.9% average increase for teachers given that teacher pay has been a top priority for them, this will be the 6th consecutive year that teachers will be earning and receiving more; (3) the Governor wants to expand Medicaid statewide, and this would include bringing an estimated 500,000 onto the Medicaid rolls at a cost of $6 billion over the next two years, which represents a 28% increase in Medicaid spending and a roughly 8% increase in total state spending.  Within the last several budget cycles the Republicans have “fixed” the Medicaid cost overruns that were in the billions of dollars. Our Medicaid Program is now operating under budget and was transformed from a fee-for-service Medicaid program to a new Medicaid managed care program. This new program has just now been recently launched. The General Assembly views further Medicaid expansion as a policy decision that “should not hold up the budget whatsoever”. To that end, they approved a provision in the budget for a special session to come back to consider Medicaid expansion after the state budget is enacted.   So you can see the impasse between the Governor’s demands and what the General Assembly believes is the best course for the entire state.

Additional items in the current budget that will be impacted due to the impasse. All of these programs are threatened due to lack of a budget by the Governor’s veto.

  • $562 Million in Pay Raises and Bonuses for Teachers and State Employees. The largest state employee pay raises in a decade
  • State Retiree Supplement
  • $91 Million for School Safety
  • $4.4 Billion for School Construction
  • $710 Million for Hurricane Recovery (Rainy Day Fund)
  • $6 Million to clear the rape kit backlog
  • $15 Million for rural broadband
  • $15 Million to fight the opioid epidemic
  • College Tuition Assistance
  • $1 Million to combat cyber security threats
  • Investments in infrastructure, state and local parks
  • $39 Million for clean water
  • A suicide prevention program for military and veterans
  • Tax relief for ALL North Carolina families

Additionally, this budget provides for:

Increasing funding for the Classroom Supplies allotment; allocates $150 per eligible classroom teacher in 2019-20 and $200 per teacher in 2020-21 to purchase supplies through an online vendor; $15 million non-recurring each year.

A 1% across the board increase in each year of the biennium for non-certified public school employees.

Provides funds to increase wages paid to direct support personnel working in group homes that care for individuals with intellectual and developmental disabilities.

Rail infrastructure needs $23 million, train station upgrades, overhauling locomotives, etc.

Most importantly, Rep. Presnell had successfully secured several key investments and grants in the state budget for District 118-Haywood /Madison/Yancey

Key provisions for District 118 include:  

Haywood County

$11,889,100 in school construction for Haywood County Schools
$125,000 for Haywood Community Living Center
$137,807 for Haywood County Innovative Court Pilot Program

Madison County

$10,666,773 in school construction for Madison County Schools
$188,305 Madison County replace election equipment
Madison County Forest Service Headquarter Funding

Yancey County

$10,572,504 in school construction for Yancey County Schools
$400,000 for Yancey County land purchase for 911 dispatch center
$3,829,850 for capital needs at Mayland Community College
$515,000 for Anspach Manufacturing School at Mayland Community College
$1,510,000 for early college classes

There are numerous other important programs in the budget that are in jeopardy if the veto is sustained.

Just Remember – on June 27th the House of Representatives voted for HB966, 2019 Appropriations Act.  The vote was 64 to 49, (3) Democrat members voted for the budget. Because of the Governor’s veto, the House will need a total of 7 Democrats voting for the budget this time around. The Democrats are under enormous pressure to “hold the line” and not vote with the Republicans to override their Governor’s veto.  It is like Russian Roulette!  We hope and pray that everyone, regardless of their party will vote their conscience and realize that their vote is important to so many of our citizens. This budget encompasses far more than several demands being made and has the potential to impact so many of our citizens.

You can find a copy of the budget here.

Rep. Michele D. Presnell  

PRESS RELEASE North Carolina General Assembly
Senator Harry Brown
July 5, 2019
Gov. Cooper’s Veto of Budget Threatens to Cancel Raises for State Employees Cooper cites lack of Medicaid expansion, which would provide health care to mostly able-bodied adults, as one of his main reasons for vetoing budget Without legislative override state employees will miss out on their largest raise in over a decade
Raleigh, N.C. – Last week, Gov. Cooper vetoed the state budget passed by the General Assembly because it did not expand Medicaid, but unless the General Assembly is able to override the veto, his decision to prioritize health care for able-bodied adults will cancel the largest pay increase for state employees in more than a decade. The legislative budget prioritizes state agency employee pay raises after years of treating them differently than teachers. Over the last five years, state agency employees have received a 7.6-percentage point pay increase compared to a 20-percentage point increase for teachers. This budget provides most state employees with a 5% salary increase by adding $220 million over the biennium. It is the largest salary increase for state employees in more than a decade. “State employees are some of the hardest working folks that we have in this state, and the budget passed by the General Assembly provides them a much needed and well deserved raise,” said Senator Harry Brown (R-Onslow). “Governor Cooper is playing a political game with the lives of thousands of state employees because he disagrees with us on one policy issue and that’s not right.” The General Assembly’s budget also provides additional raises and supplements to state employees that put their lives on the line every day working in dangerous environments. Prison employees that work in facilities with the highest vacancy rates will receive an annual salary supplement of at least $7,500. State Bureau of Investigation and Alcohol Law Enforcement officers will also receive an additional raise by having their salaries tied to the same salary schedule as highway patrol officers.