New healthcare legislation including Medicaid expansion (HB 149) was passed by the North Carolina State Senate on June 1 by a near-unanimous vote. The measure has been sent to the House for consideration. The income threshold for Medicaid coverage would increase from 100% to 138% of the federal poverty guidelines and provide healthcare access for up to 600,000 uninsured low-income people and families.
Republican Phil Berger, the highest-ranking officer of the Senate, strongly supports Medicaid expansion. He cites the durability of the federal promise to defray the state’s cost for Medicaid expansion by 90% and recent improvements in how Medicaid is administered. House Republican leader Tim Moore, the Speaker of the House, is opposed to the bill in its current form and does not feel there is sufficient Republican support so the bill may not be filed during the short General Assembly session this year. The House would have to approve the bill before heading to Gov. Roy Cooper, who is a long-time supporter of expanding Medicaid. He said on May 11, “I believe that we’re getting closer than ever to an agreement.”
The proposal eliminates the certificate of need law, covers telehealth services, prevents surprise medical bills from out-of-network providers, and allows advanced practice registered nurses to provide patient care without physician supervision. The state’s cost for expanding Medicaid would be covered by hospital assessments, and the expansion would end if the federal government reduces state subsidies. Erica Smith Palmer, the executive director of Care4Carolina, a nonprofit organization that advocates for expanding access to health care in North Carolina, notes, “We look forward to making 2022 the year we close the coverage gap for all those without an affordable option for health insurance.”
Previously, I wrote an opinion piece about the new healthcare committee that would study how to improve healthcare access and expand Medicaid in North Carolina, one of 12 remaining non-expansion states. A majority of North Carolinians want to improve the health of low-income persons and expand Medicaid according to a 2020 poll. However, the legislature has resisted any attempt to pass Medicaid expansion until now and, years ago, had passed a law that disallows voter referendums blocking attempts by voters to circumvent the legislature. Therefore, I suggested that “there is a path going forward by either persuading the legislature to move ahead with Medicaid expansion or replacing them with representatives who will listen to their constituents.”
Medicaid is essential to the healthcare safety net and has provided access to many people who lost their jobs and health insurance as a result of the COVID-19 pandemic. The program currently covers almost three million people in North Carolina yet more than one million people, almost 13% of the population, do not have health insurance including 30,000 Buncombe County residents.
Although the Affordable Care Act in 2010 legalized Medicaid expansion, the Supreme Court ruled that each state had the right to decide. A stalemate between Gov. Cooper, a Democrat, and a Republican-dominated legislature over the inclusion of Medicaid expansion in the 2022 annual budget resulted in the creation of the bipartisan Joint Legislative Committee on Access to Healthcare and Medicaid Expansion in February. The Committee is comprised of nine senators and nine representatives.
Republicans are generally opposed to expanding Medicaid for fear of rising taxes and bankrupting the state. However, the US Congress has voted to defray each state’s cost for Medicaid expansion by 90%, and state hospitals and healthcare systems have agreed to provide funds to cover most of the balance.
Tim Moore said that bill might be a better fit for consideration during the longer general assembly session next year. However, the health care of millions of thousands of North Carolinians may be delayed due to the politics of negotiating next year’s state budget.
We need to continue our successful grassroots effort to remind our representatives that a strong bipartisan majority of North Carolinians want to expand Medicaid to improve the physical and financial health of low-income persons. A call to action should include letters and phone calls to the health access study committee members, at https://www.ncleg.gov/Committees/CommitteeInfo/NonStanding/6770, and to your district representatives. Consider joining an organization that supports expanding access to health care. Without the ability to have a vote referendum in North Carolina, the will of the people may be stalled. Therefore, it is of the utmost importance for everyone to persuade each member of the committee and especially the House to support Medicaid expansion or to vote for representatives that do.
Richard Needleman is a retired orthopedic surgeon and a member of Doctors for America.