Last week I asked if North Dakota was in a position to pay more for Medicaid Expansion. Under the Republican repeal and replacement of Obamacare – which was enthusiastically supported by Rep. Kevin Cramer – that is exactly what would be expected of our state. A new projection by Republican U.S. Senator Bill Cassidy states North Dakota could expect to pay 400% more for the Medicaid Expansion population.
The state’s dismal budget situation makes that transition more difficult. The question is, will the Republican Legislature be willing to pick up a 400% increase in state spending for the Medicaid Expansion population, or would they simply drop that coverage and potentially leave those covered in limbo. In addition, it is not just the coverage of individual’s health care, Medicaid Expansion has been a life line for rural hospitals. It wasn’t just consumer advocates pressing the Legislature to expand Medicaid under Obamacare; it was the hospitals and the Greater North Dakota Chamber of Commerce. The expansion has been good for North Dakota business. With all that said, I’m still not optimistic because of the unsustainable budget the Republicans have left after this session.
Some people are holding onto hope because the Senate needs to work on the rushed House version Kevin Cramer helped narrowly pass. Don’t get too optimistic when it comes salvaging Medicaid Expansion. Yesterday it was reported the Senate Republicans are focused on killing Medicaid Expansion. The effort is spearheaded by South Dakota U.S. Senator John Thune who said, “At some point you’re gonna get back to the original [reimbursement rate], it’s just a question of how quickly that happens.” What Thune is saying is instead of North Dakota receiving 90% of Medicaid Expansion’s expense coming from the Federal government, the reimbursement would go to the same as traditional Medicaid. Currently, that reimbursement is 50-50. The Republican debate in Congress right now isn’t whether to keep Medicaid Expansion; it is when will it be phased out.
North Dakota is not in a budget situation to pick up the costs unless a dramatic uptick in our economy occurs. Even then, it would take a little more to cover this expense to help our neighbors and rural hospitals. Political courage being one. If this burden shifts to the state, I’m curious if the North Dakota Chamber of Commerce, the Hospital Association, AARP, and the other various interests groups will rally behind the cause again.