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Jan. 31--RALEIGH -- The state Senate's insurance committee approved a bill Thursday that would block the expansion of Medicaid to poor adults in North Carolina and require the federal government to operate all aspects of the state's health insurance exchange as part of the Affordable Care Act.
A contentious discussion among several members of the committee preceded a voice vote on the bill, which now is expected to move to the Senate floor.
"We all know we are going to be dictated to by the federal government, so if they want to do it, just let them do it," said Sen. Tom Apodaca, a Republican from Hendersonville and one of three primary sponsors of the bill that bans state involvement in the health insurance exchange now and for the future.
A vocal opponent was Sen. Floyd McKissick, a Democrat from Durham who argued that the state would be "better served with a state-run exchange."
"Are we ready to relinquish that authority?" McKissick asked.
McKissick also asked to see information on how the bill would impact the state financially, but Apodaca brushed off the request.
"I know you don't like this, but we are going to get out of this meeting," he said, urging McKissick to cut short his comments.
Under the Affordable Care Act passed by Congress in 2010, each state must establish a health insurance exchange where private health care plans are available to the public. Each exchange must offer a variety of coverage levels, including a basic package that covers preventative care as well as major medical expenses at low cost.
Each exchange also must allow consumers to compare plans and prices.
The act allows states to set up their own exchanges or hand some or all of the responsibility to the federal government.
North Carolina has been following steps that would allow the federal government to operate the statewide exchange during the first year, beginning January 2014, but would allow the state to operate an exchange jointly with the federal government in the future.
The legislation proposed by the Senate, known as "No N.C. Exchange/No Medicaid Expansion," would block the state from participating in the creation or operation of the insurance exchange.
Asked about state Health and Human Services Department's support for state involvement in the exchange, Apodaca said: "I'm sure the department would love to have the money. Have you ever seen a public bureaucracy that didn't?"
Rose Vaughn Williams, attorney for the N.C. Department of Insurance, told the committee that refusing to expand Medicaid would result in North Carolina helping to subsidize other state's Medicaid coverage through federal taxes.
Williams also said state health department staff, insurance company representatives and others have met regularly for two years and nearly completed work on a system for individuals and families to get information about and participate in the insurance exchange. That work was funded by a $13 million federal grant.
A $73 million grant also awarded for implementing the insurance exchange and tying information from the program into the state's health care and technological databases has not yet been spent, Williams said.
Called to the podium to address the committee, Williams said she was happy to have the opportunity to speak, but said "the natural instinct is not to step in front of a moving train."
A few minutes later, the committee voted to approve the bill.
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