If you are wondering what North Carolina has to do to comply with the Affordable Care Act now that the Supreme Court has said it passes constitutional muster, there are better places to look than my blog.  But there's an excellent post from Professor Jill Moore at the UNC School of Government.  It's on the School of Government's Coates' Canons blog, which I highly recommend you add to your reading list if you practice law in North Carolina.

Health Benefits Exchange

North Carolina is behind the curve on the ACA front on establishing a health benefits exchange.  The concept of an HBE "is to create an insurance pool so that uninsured people may purchase health insurance at lower rates than are typically available to individuals in the present market."  North Carolina isn't the only state to have deferred creating an HBE, only 15 states have put an HBE in place in anticipation of the full deployment of the ACA.  But there's a deadline.

North Carolina's motivations were good.  The General Assembly passed a bill last year stating its intention to create an HBE.  The state House passed legislation doing exactly that, but the state Senate hasn't considered that legislation yet.  Given that the Act requires that a state creating its own exchange must "demonstrate operational readiness by mid-2013 and begin operating in 2014,"  NC is in a crunch on the HBE issue, especially since the Senate isn't expected to reconvene to consider this issue until next year, after the November elections.

Medicaid Expansion

There also a major issue about Medicaid.  The ACA expands Medicaid to cover a large population of low income adults.  That's going to involve substantial expense which the federal government will mostly bear until 2020, when the states will be responsible for 10% of the increase and the federal government 90%.

A U.S. Senate Committee report estimates North Carolina's increased costs to cover the expanded Medicaid program at $1.791 billion between 2014 and 2019.  Even Governor Perdue has expressed concerns about North Carolina's financial ability to cover nearly half a million estimated new Medicaid recipients.

Given that the Supreme Court's decision gives the states the option to opt-out of the expansion,  North Carolina has a difficult decision about whether to participate.  Many states are reported to be pondering exactly that.

Since the Republicans currently control the North Carolina General Assembly, and have a serious run ongoing for the Governorship, you can expect the dialogue over Medicaid expansion to be acrimonious after Election Day.