Up and Coming Weekly is a weekly publication in Fayetteville, NC and Fort Bragg, NC area offering local news, views, arts, entertainment and community event and business information.
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4 UCW AUGUST 17 - 23, 2022 WWW.UPANDCOMINGWEEKLY.COM For more than a decade now, advocates of the Affordable Care Act have pressed the North Carolina General Assembly to implement the federal law's most expansive and expensive ele- ment: expanding Medicaid to virtually all low-income adults. Every year, advocates have left the legislature disappointed. ey left disappointed at the end of the 2022 legislative ses- sion, too. I wish it was because most lawmakers resolutely rejected Medicaid expansion. I'm no fan of the policy, which would add hundreds of thousands of North Caro- linians to the public dole and widen the federal government's already massive budget deficit. But lawmakers who once expressed similar concerns, including House Speaker Tim Moore and Senate leader Phil Berger, have switched their posi- tions. Medicaid expansion now enjoys bipartisan support in both chambers, however much I might wish otherwise. (Of course, if I thought wishes could al- ter reality, I wouldn't be a conservative.) So why didn't expansion happen this summer? Gov. Roy Cooper hit the nail on the head last week when he blamed the intransigence of North Carolina's hospital executives, whom he urged to "step up and compromise with the state legislature." eir lobbying arm, the North Caro- lina Healthcare Association, quickly responded with letters to Cooper, Moore and Berger as well as full-page ads in many of the state's largest newspapers that shifted the blame back on lawmak- ers. Hospital execs "are not elected to office, and therefore we are not the ones standing in the way of passing legisla- tion," wrote the president of the associa- tion, Steve Lawler. "at burden, and opportunity, lies with your branches of government." e dispute isn't really about Med- icaid expansion anymore. It's about an archaic regulatory system called certifi- cate of need, or CON. North Carolina requires hospitals, physician practices and other providers to get a permission slip from the state to add a new loca- tion, expand an existing one or make other major investments in equipment or services. When CON was concocted decades ago, its proponents believed such a regulatory apparatus would keep prices down by discouraging the overutiliza- tion of services. en reality intruded. By limiting competition, CON created monopolies and cartels that tended to drive prices up and quality down, just as they do in most other sectors of the economy. I've written many times about the ad- verse effects of this wrongheaded policy. During the pandemic, for example, jurisdictions with strict CON laws had a harder time meeting the demand for hospital beds and medical care. Some states, including North Carolina, enact- ed temporary respites from the regula- tions — a decision that, according to a study published earlier this year in the Journal of Risk and Financial Manage- ment, led to a "reduction in mortality resulting from COVID-19, septi- cemia, diabetes, chronic lower respiratory disease, influenza or pneumonia, and Alzheimer's Disease." In the version of Medicaid expansion passed by the North Carolina Senate, this temporary relaxation would be replaced with permanent decontrol. e House version left out CON reform, though it appears that lawmak- ers in both chambers would be inclined to work something out in the absence of heavy pressure from hospitals loath to give up their CON-protected fiefdoms. is is what Cooper is talking about. As a Democratic governor facing a Republican-controlled legislature, he has been unable to get much of his policy agenda enacted into law. His administration has been largely one of executive orders and vetoes, not signing ceremonies. Still, Medicaid expansion has been a top goal for six years — and now Berger and Moore have walked very far in his direction. With a deal so tantalizingly close, Cooper's frustration is both un- mistakable and understandable. "When pretty much everybody agrees that we ought to expand Medicaid in our state," he said, "it's important to go ahead and get it done." I don't agree, but I'm just a lowly scribbler. Steve Lawler and his members could make expansion happen this year if they budge on CON. Or perhaps law- makers will defy this powerful interest group. I admit it — I'm not sure which side to root for. 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Box 53461 Fayetteville, NC 28305 PHONE: 910-484-6200- FAX: 910-484-9218 Up & Coming Weekly is a "Quality of Life" publication with local features, news and information on what's happening in and around the Fayetteville/Cumberland County community. Published weekly on Wednesdays, Up & Coming Weekly welcomes manuscripts, photographs and artwork for publication consideration, but assumes no responsibility for them. We cannot accept responsibility for the return of unsolicited manuscripts or material. Opinions expressed by contributors do not necessarily reflect the views of the publisher. The publisher reserves the right to edit or reject copy submitted for publication. Up & Coming Weekly is free of charge and distributed at indoor and outdoor locations throughout Fayetteville, Fort Bragg, Pope Army Airfield, Hope Mills and Spring Lake. Readers are limited to one copy per person. © 2020 by F&B Publications, Inc. All rights reserved. Reproduction or use of editorial or advertisements without permission is strictly prohibited. Various ads with art graphics designed with elements from: vecteezy.com and freepik.com. PUBLISHER'S PEN Association of Community Publishers Will hospitals kill Medicaid expansion? by JOHN HOOD JOHN HOOD, Board Member, John Locke Foundation. COMMENTS? Editor@upandcomingweekly.com. 910-484-6200 82 64 82 83 79 82 63 64 83 66 64 65 THU AUG 18 FRI AUG 19 SAT AUG 20 SUN AUG 21 MON AUG 22 TUE AUG 23 88 69 90 71 89 71 91 71 91 71 91 72 Scattered Thunderstorms Scattered Thunderstorms Scattered Thunderstorms Scattered Thunderstorms Isolated Thunderstorms AM Showers Photo courtesy of Pexels.