GARY D. ROBERTSON
RALEIGH, NC (AP) -- While other Southern states already have drawn the line on the federal health care overhaul, North Carolina doesn't seem quite settled on whether to commit to insuring hundreds of thousands more people starting in 2014.
President Barack Obama's Affordable Care Act was largely upheld by the US Supreme Court in June, but the justices ruled that states can't be penalized if they refuse to expand their Medicaid eligibility requirements to cover more uninsured adults, as the law directs.
Governors in five other states already have said they won't participate. North Carolina politicians say they want more information before deciding which way they think state government should go.
"I think that North Carolina is more in a wait-and-see mode," said Rep. Nelson Dollar, R-Wake, one of the state House's chief budget-writers.
Democratic Gov. Bev Perdue is still evaluating "what's in the best interest of North Carolina families and North Carolina taxpayers," spokeswoman Chris Mackey said. But since she leaves office in January, Perdue's successor will likely set the tone on any expansion, which could cost the state hundreds of millions of dollars to carry out.
The General Assembly, which is currently in Republican hands, also will have a say. The Affordable Care Act also could be dismantled or reworked if Mitt Romney is elected president and both houses of Congress have Republican majorities.
The major-party candidates for governor, Democratic Lt. Gov. Walter Dalton and Republican Pat McCrory, have differing views on the wisdom of the Affordable Care Act. But both cautioned against rushing into expanding North Carolina's Medicaid rolls, which currently total almost 1.6 million people - most of them poor children, older adults and the disabled.
"Right now, I think we need to look at all the options that are available and see what the ramifications are," McCrory said recently. But the former Charlotte mayor also said that, if elected, he would work with other governors and the next president to repeal the Affordable Care Act and replace it with "a more flexible system for each state."
Consumers benefiting most from the Medicaid expansion would be adults earning slightly above federal poverty guidelines. The federal government would pick up the entire bill for newly eligible enrollees through 2016, with the state's share ultimately rising to 10 percent.
While figures are being updated by the state, the nonpartisan North Carolina Institute of Medicine cited 2011 figures showing the Affordable Care Act could increase state Medicaid enrollment by 559,000 by 2019.
The state's share would cost $830 million from 2014 to 2019, with the federal government paying more than $15 billion, an institute report said. The amounts include the state paying more for some new enrollees that already would qualify under current Medicaid rules.
Dalton said the Affordable Care Act should be amended but not repealed. He said he wants to know the fiscal impact of the federal influx of Medicaid funds. Critics of the Republican state budget have said Medicaid cuts are eliminating private-sector health care jobs.
"If we have an infusion of $15 billion, does that convert to jobs in the allied health care field, where we need jobs?" Dalton asked, adding he needed more answers before deciding on his expansion recommendation.
Rep. Verla Insko, D-Orange, wants the expansion because she said fewer uninsured people would end up in expensive hospital emergency rooms for routine treatment. Insko said whether North Carolina will participate in the expansion likely will come down to who's in charge of state government, with the Republicans more likely to say no.
Senate leader Phil Berger, R-Rockingham, said the Legislature would think twice before committing to expanded Medicaid coverage because the state program has been beset by shortfalls.
"It's a huge budget driver," he said.
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