UPDATED: Pat McCrory is aligning himself with a cadre of conservative Republican governors who are resisting money in President Barack Obama's health care law to expand Medicaid.
The U.S. Supreme Court ruling on the Affordable Care Act gave states the option to accept millions in federal aid to expand Medicaid health care coverage in 2014. In North Carolina, where 17 percent of the population is uninsured, the expansion would initially add roughly 525,000 residents to the program. The number grows to 560,000 by 2019 with about 75 percent of those being uninsured.
Through a spokesman, McCrory said he opposes taking the money at this point. "It would be irresponsible for North Carolina to now automatically accept the federal money before knowing the immediate and long term costs of the law and its impact on our already fragile economy and budget," a statement from the Republican's campaign read.
But McCrory later appeared to walk back his statement, telling reporters Wednesday: “I think one of the options might be to turn it down. But I don't think there is enough information about what those ramifications are. We don't the rules and procedures."
His Democratic rival, Walter Dalton, said he doesn't know where he stands. "It's a big issue involving a lot of money and a complex decision. He needs to study it further," campaign spokesman Schorr Johnson said.
The Medicaid expansion question is one of the first and most important decisions the next governor will handle. Republican governors like Rick Perry in Texas and Nikki Haley in South Carolina have already made it clear that they don't want the federal money. Under the health care law, the expansion would cover anyone earning less than 138 percent of the federal poverty level, or roughly $32,000 for a family of four, experts said.
McCrory's campaign said it is committed to seeing the federal health care law repealed. His reason for opposing the expansion is linked to the cost. "We cannot crowd out funding for key priorities like education, criminal justice and infrastructure or impose job-killing taxes that may threaten our economic recovery," spokesman Ricky Diaz said.
The Republican-controlled state legislature is studying the issue and waiting for the new governor's input, said Rep. Nelson Dollar, a Cary Republican and Medicaid guru. Again money appears to be the issue. "From the initial numbers, it looks very problematic as to where the money would come from to afford the expansion," he said.
The state Department of Health and Human Services didn't respond to questions.
For the first few years, the federal government would pay the entire cost for newly eligible people. The reimbursement will drop to 90 percent by 2019. Typically, Medicaid pays two-thirds of the state's Medicaid costs, and the state pays the rest.
The state Medicaid office estimated that adding 560,000 people to Medicaid would cost the state $830 million over six years and bring in $15 billion in federal money over that time. The bulk of that cost is not from the newly eligible people -- but rather those currently eligible who are not on the Medicaid rolls.
"We are going to pay whether we expand or not," said Pam Silberman, the president of the N.C. Institute of Medicine, which published the most comprehensive study about the federal health care law in North Carolina.
The calculation leaves the true cost of expanding Medicaid still unknown. The institute hoping to release updated numbers soon.
Talking to reporters, McCrory addressed the issue of exchanges, siding with Republican lawmakers who don't want to move forward at this point. "Right now I think it would be foolish to start setting up exchanges unless we know what the real ramifications of the Medicaid options,” McCrory said after an event on Wednesday.
He said the Perdue administration should have been working on this for the past several years.
“I am not govenror at this point," McCrory said. "But the fact of the matter is, I think we need to look at what the options are. In the meantime, I am going to work with other governors to get this overturned and set up a more flexible system for each state.''