There are two aspects of Obamacare that are optional for the states. One is the creation of the health care exchanges, which are the instrument through which the government will control the insurance market. The states can either implement their own exchange (which the federal government must approve), partner with the feds on an exchange or allow the federal government to implement the exchange.
So far, North Dakota’s leaders up to and including Governor Jack Dalrymple have resisted this implementation, for a lot of excellent reasons. But the other part of Obamacare, made optional by the Supreme Court ruling upholding the law, is the expansion of the state’s Medicaid program.
The federal government funds the expansion, for now, but there’s no guarantee that funding would stay in place in the future. Which is why states should be saying no to the expansion. Unfortunately, in his executive budget, Governor Dalrymple says yes.
From HB1012, the Department of Human Services budget (see below), submitted at the behest of the governor:
SECTION 3. APPROPRIATION – AUTHORIZATION – DEPARTMENT OF HUMAN
SERVICES. In addition to the amounts appropriated to the department of human services in section 1 of this Act, there is appropriated any additional federal funds from the Patient Protection and Affordable Care Act [Pub. L. 111-148], as amended by the Health Care and Education Reconciliation Act of 2010 [Pub. L. 111-152], to implement the provisions for the medicaid expansion. All federal funds received for the medicaid expansion are hereby appropriated to the department of human services for the biennium beginning July 1, 2013, and ending June 30, 2015.
There are three good reasons to support removing this implementation from the DHS bill.
First, North Dakotans overwhelmingly oppose Obamacare. Governor Dalrymple has no business trying to implement any part of that controversial law.
Second, North Dakota has a booming economy. There is no need to expand health entitlements in the state.
Third, in addition to North Dakota not needing an expansion of this program, the federal government is broke. While there is a promise in place for the feds to fund this expansion for now, there’s no guarantee that the federal government will continue funding the expansion in the future. Especially given the fiscal shape the federal budget is in. The most likely scenario, should North Dakota implement the expansion, is that the feds will pull their funding and state taxpayers will be stuck paying for this.
Democrats are happy with Dalrymple’s decision. State Senator Tim Mathern, one of the few outspoken proponents of Obamacare in the state, is applauding the decision. “I thank the Governor for recognizing that the families of North Dakota will benefit greatly from Medicaid Expansion,” said Mathern after pulling his own bill authorizing the expansion from consideration. “This expansion is meaningful action on behalf of people not able to pay for insurance and for the healthcare providers who treat these individuals.”