Contention over Medicaid expansion will resume next year in NC

North Carolina lawmakers seem poised to take another stab at expanding Medicaid next year.

But many of the same sticking points between the state House and Senate on health care policy that precluded Medicaid expansion passing in this year’s legislative session will continue into the one that starts in January.

“You won’t get it for Christmas, but hopefully a New Year’s wish,” Sen. Jim Burgin, a Harnett County Republican and a supporter of Medicaid expansion, said during a Raleigh health care forum Thursday hosted by the American Cancer Society Cancer Action Network.

“We’re going to get there,” Burgin said. “I can’t tell you the month. I would like to think it is going to be much earlier in the year than later in the year. I don’t want to be here at the end of 2023 talking about what we’re still working on. It’s too much money we’re leaving on the table and too many people that are invested,” Burgin said.

Burgin is chairman of the Senate Health Committee and the Senate Health Appropriations Committee.

North Carolina remains one of just 11 states yet to adopt Medicaid expansion under the Affordable Care Act, according to research by Kaiser Family Foundation. The law colloquially known as Obamacare expanded the insurance program to nearly all adults with incomes up to 138% of the federal poverty level.

Medicaid provides health insurance coverage to certain low-income and needy individuals via state and federal funds. In North Carolina, childless adults are not eligible for Medicaid, while the current income limit eligibility for a parent or caretaker is 41% of the federal poverty level.

Medicaid expansion would make 600,000 low-income North Carolinians eligible for the program as well as increase access to health care across the state, particularly in rural communities, according to the state Department of Health and Human Services.

Asked why Medicaid expansion hadn’t passed, Burgin said it’s largely because of the disagreements between the House and Senate on the regulations known as certificate of need. This law requires health care providers to get approval from the state for new health care facilities, medical equipment purchases and more. Burgin said another reason is that North Carolina, until last year, did not have Medicaid managed care, which allows the state to know the per-person cost of Medicaid health benefits and additional services.

Dispute between House and Senate

The Senate, in a near-unanimous vote in June, passed a bill to expand Medicaid and make changes to certificate of need regulations. The House passed its own bill shortly after — without CON changes — which authorized a study to be followed by a vote on expansion itself in December, as previously reported by The News & Observer.

In a written statement in September to The N&O, Senate leader Phil Berger, a Republican from Eden, said that the state’s CON regulations “increase costs and artificially reduce the availability of healthcare.”

But House Speaker Tim Moore, a Republican from Kings Mountain, told reporters in August that Medicaid expansion should not be tied to CON reform.

“If folks are really serious about wanting to fix expansion, we can take care of expansion, and deal with all that other stuff at a later date,” Moore told The N&O in August.

The North Carolina Healthcare Association, an interest group that represents hospitals, prefers a state House bill that expands Medicaid without changes in the CON law. In a statement in September, the association warned that changes in the law could lead to hospitals losing millions of dollars if other providers can offer lucrative services, as reported earlier by The N&O.

Closing the gap

For Kody Kinsley, DHHS secretary, “There’s nothing more fundamental that we could do in North Carolina in closing the coverage gap,” he said during Wednesday’s health care forum.

According to Kinsley, North Carolina has already left on the table about $40 billion in federal funding but can still get a $1.5 billion “signing bonus” from the federal government that would pay out over two years. In 2021, the federal government, under the American Rescue Plan Act, temporarily increased the federal government contribution for Medicaid expansion to states that have not passed expansion.

“We’re never going to get back the 40ish billion dollars that we left on the table by not expanding Medicaid; $40ish billion that would have flowed into the health care system,” Kinsley said. “For 10 years, where would we have been at the start of COVID? Where would we have been in many other situations? We won’t get that,” Kinsley said.

“But if we can get $1.5 billion, I think we can make a difference. And I think we can focus that on what I hear as being a consistent priority with everyone I speak to, which is mental health. I also hear ... the clear priority that we can help children and their mental health and the need to recreate a system of care that is more community based, more in-home with wraparound services that make a difference in children,” Kinsley said.

Burgin said he hopes a deal could emerge behind the scenes.

“The House is talking to hospitals and other folks, ‘‘ he said.

“I’m a businessman,“ he said. “... When I’m buying a building or a business or selling stuff, I don’t put it into paper. I don’t talk about it publicly, I talk about it privately.”

“That’s what I’ve encouraged all of them to do,” he said. “Private conversations with Sen. Berger and the speaker and governor and secretary, whoever else needs to be involved. To work things out and then have an announcement: ‘This is what we’re going to do, folks.”

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