NC Medicaid expansion bill moves through key committees

RALEIGH, N.C. (WNCN) – A bill expanding Medicaid coverage in North Carolina quickly moved through key committees Tuesday ahead of expected votes in the state House of Representatives later this week.

The bill would lead to about 600,000 people gaining coverage. Most are working adults who make too much money to qualify for Medicaid but not enough to afford insurance.

While the bill is expected to pass with bipartisan support, it remains unclear how legislative leaders will reach a compromise on a bill to send to Gov. Roy Cooper (D).

The state Senate passed a Medicaid expansion bill last year that included various regulatory reforms aimed at increasing access to health care, but the House has resisted including those along with expansion.

"Let's have those discussions, open and productive. And then we can come back with a comprehensive bill that hopefully can get passed by the General Assembly before those deadlines," said Rep. Donny Lambeth (R-Forsyth), a retired hospital executive who has been working to try to build support among Republicans to expand Medicaid. "We can make North Carolina a better state if we move forward in improving access to care."

While the bill moved forward Tuesday with little debate, Rep. Lambeth said House Republicans met behind closed doors Monday discussing it for more than three hours, as some in his party remain opposed. Lambeth expects the bill to pass the House by a wide margin.

The federal government covers 90 percent of the cost of expansion. The House bill includes provisions to end expansion if that drops below 90 percent. Expansion also would be conditional on a state budget being approved.

If North Carolina approves Medicaid expansion, it would mean billions of dollars coming to the state. An analysis by nonpartisan staff at the General Assembly says the hospitals would receive about $3 billion annually for services provided to patients. Congress also authorized an additional incentive to the 11 states that have not expanded Medicaid, which would mean North Carolina would receive an added bonus of about $1.8 billion over two years.

Rep. Lambeth says that money could be used to fund mental health treatment programs, workforce development and incentives for health care professionals to move to underserved rural areas.

Senate Republicans have wanted to include reforms to the state's certificate of need laws that address hospital competition and to allow advanced practice nurses to operate more freely without direct supervision by a doctor.

Senate leader Phil Berger (R-Rockingham) was critical of the House bill.

"The title is Access to Care and yet it doesn't do anything to increase access in terms of facilities or personnel," he said. "It's not the bill we need in North Carolina expanding Medicaid."

Gov. Roy Cooper (D), a long-time supporter of Medicaid expansion, urged Republicans to find a compromise soon. Beginning this spring hundreds of thousands of people who qualified for Medicaid coverage due to the COVID-19 emergency will lose that coverage.

"People will have to go off and then back on again, which will be a nightmare for social services departments all across the state," said Cooper. "Trying to get this passed in March is absolutely critical."

Some conservatives remain opposed.

"Medicaid expansion will not only grow the size of government, it will also place those currently on Medicaid — our state's neediest residents — in a bind as they compete with a population of able-bodied, working-age adults for health care access," said Donald Bryson, president of Civitas Action.

As the House bill moved forward Tuesday, advocates delivered valentines to legislators reading "Love they neighbor."

Ricky Clay, of Wilmington, has been with and without health coverage. When he was 19 he began to be treated for an issue in his spine, but he lost coverage years later.

"I was addicted to medicine by then. It was narcotics. So, sometimes I had to do what I had to do to get it," he said. "I was so sick from not having medicine, sick from the pain. And, that's why I ended up in the (criminal justice) system."

Clay is working now for a company that installs showers but does not have health coverage.

"If we had better healthcare, maybe people would stay out of the system, stop going to prison, have means and capabilities to take care of their health," said Clay. "I work every day, and I try. I'm not just a lazy American that wants the government to give me insurance or take care of me."