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Letter To The Honorable Nancy Pelosi, Speaker, U.S. House Of Representatives


Location: Washington, DC

Delegation Letter To Pelosi -- Treat NC Fairly

U.S. Rep. Howard Coble (R-NC) and three of his House colleagues from North Carolina sent a letter to House Speaker Nancy Pelosi urging her to not burden North Carolinians with over a billion dollars in new Medicaid costs and to make sure the state is treated equally in the final version of the bill.

Both the House and Senate versions of the bill would mandate that states raise their Medicaid enrollments and pay for much of the cost themselves. According to an estimate by the National Conference of State Legislators, the Democrats' proposal would cost North Carolina at least $1.216 billion over five years. Governor Perdue has told reporters that even though she supports the overall bill, she would oppose it if North Carolina is forced pay for an unfunded Medicaid mandate.

The full text of the delegation's letter is below along with quotes from individual delegation members and Governor Perdue:

Congressman Howard Coble:

"So, North Carolina, already facing a massive budget shortfall, is expected to shoulder a greater share of Medicaid costs, while sweetheart deals are handed out to states such as Nebraska and Louisiana. This is patently unfair and probably unconstitutional. I urge the Speaker to kill this backroom deal and restore fairness to the process."

Congressman Walter Jones:

"Taxpayers have had enough of this Administration's broken promises for transparency in the crafting of this health care reform bill. Backroom deals like the one that produced this massive new unfunded mandate for Medicaid expansion are the last thing taxpayers need during these difficult economic times."

Congressman Patrick McHenry:

"North Carolinians can't afford a huge new Washington spending plan and we definitely can't afford the insider deals Democrats handed out to a few well-connected Senators. We need to focus on reviving our economy, not crushing it with an expensive new mandate."

Congresswoman Sue Myrick:

"Increasing the Medicaid burden on our state is only going to increase taxes for our citizens at a time when people are already struggling to make ends meet. Instead, let's work on creating a solution to healthcare costs that doesn't burden already strained public programs at the expense of our citizens."

Governor Bev Perdue:

"We are all hungry for a solution," she said, "but the absolute dealbreaker for me as governor is a federal plan that shifts costs to the states." (1/14/2010, Lincoln Tribune)

"North Carolina, as many other states, really (doesn't) have the money for unfunded mandates," Perdue said. "It's going to be very hard for us to pick up (an estimated 350,000 to 500,000) new Medicaid patients unless we have some more help from the federal government." (12/28/2009, Greensboro News & Record)


Dear Speaker Pelosi,

As the final health care reform bill is being negotiated between the two chambers, we wanted to express our concern as to how some of the proposed changes will affect the state of North Carolina.

Both the House and Senate versions mandate that the states raise their Medicaid enrollment and pay for a portion of that cost. According to the Congressional Budget Office, this proposed Medicaid expansion will cost states $26 billion over the first ten years. Just last month, Lanier Cansler, Secretary of the NC Department of Health and Human Services, announced that current Medicaid spending is expected to exceed the state budget projections by $150 million to $300 million. It is apparent that the estimated costs of this additional expansion of Medicaid would further drain our state coffers, forcing our legislature to make even greater reductions in current services.

North Carolina is not alone in facing the burden of this unfunded mandate. The National Conference of State Legislatures made this same argument in a letter to Congressional leaders in October asking for 100% funding by the federal government for any Medicaid expansion, stating, "A lesser commitment from the federal government would shift billions of costs to states and would have serious short- and long-term consequences for state budgets."

Unfortunately, in the Senate bill only Nebraska will have the federal government pick up 100% of the cost of the Medicaid expansion. Vermont will receive an additional $250 million over six years, and Louisiana will reportedly receive an additional $300 million.

The state of North Carolina can not endure the weight of a massive new spending requirement. We request that any final healthcare bill not result in unfunded mandates on our state and we further request that all states be treated equitably. Thank you in advance for your consideration of our request.


Congressman Howard Coble

Congressman Walter Jones

Congressman Patrick McHenry

Congresswoman Sue Myrick

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