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There is a lot of confusion about how Medicaid expansion is paid for. Medicaid expansion is part of the ACA (Affordable Care Act) of 2010. Medicaid expansion is paid for from a percentage (3.8%) of every person’s insurance premium.

This insurance premium tax has been collected since 2010 regardless of if your state expanded Medicaid or not. North Carolina has been forced to send our collection of this money, totaling $1.6 billion, to the federal government since 2010 and has received nothing in return for it.

Medicaid expansion is a federal program that is not funded by state or federal personal income tax. If an individual state chooses to participate, it is required to pay 10% for the program.
North Carolina and some other states require the hospitals in their state to pay that 10%. The hospitals can afford to do this because around 40% of the free care they provide can now be paid by Medicaid, due to expansion. Also, rural hospitals receive federal funds to help them (HASP funds). Atrium Stanly had been losing $2 million a month, but because of Medicaid expansion they are now profitable. The hospital will now be able to keep their birthing center open as a result.

It should be good to know that every Republican in the House and Senate voted for Medicaid expansion. One reason is because the federal government, in return for expanding Medicaid, has returned the $1.6 billion to North Carolina that they have collected since 2010. North Carolina is spending that money on mental health.

Another reason is that there is not one dime of state or federal personal income tax being put into Medicaid expansion. Under Republican leadership, North Carolina has cut your state personal income tax rate over the last nine years from 7.75% to 4.6% and is on track to cut it to 2.99%.

North Carolina is the 40th state to expand Medicaid.

Rep. Wayne Sasser