Medicaid expansion could mean health care changes for North Carolina

RALEIGH, NC (WNCN) — After referencing their years of opposition to the idea, leading state Senate Republicans on Wednesday explained why North Carolina should expand Medicaid coverage to more half a million people.

It’s a decision Democrats have been asking them to make for a decade. The bill would also make a variety of other reforms that Republicans say are needed to address concerns about access to health care.

“If there is one person in the state of North Carolina who has spoken out against Medicaid expansion more than me, I would like to meet that person. In fact, I’d like to talk to that person about why my perspective has changed,” Republican Senate Leader Phil Berger said. “It’s the right thing to do for us.”

Republicans have been at odds with Democratic Gov. Roy Cooper on this issue throughout his tenure, with Medicaid expansion a key reason Cooper refused to sign a budget during his first term.

North Carolina is one of 12 states that has not expanded Medicaid since the Affordable Care Act passed.

“Governor Cooper is encouraged to see progress toward more people being covered by health care in North Carolina and will carefully review this legislation,” said Jordan Monaghan, spokesman for Cooper.

It is estimated that about 600,000 low-income people would be eligible for Medicaid coverage if the bill were passed.

The federal government pays 90% of the cost for states to expand Medicaid. As part of the U.S. bailout, which Democrats in Congress passed last year, they included a provision that temporarily increases the federal share to 95% in an attempt to incentivize leaders of non-expanding states like North Carolina to approve Medicaid expansion.

Republicans note that the state would receive about $1.5 billion over two years for Medicaid expansion.

Senator Berger had worried about whether the federal government would continue to pay its share. Berger says he’s now confident that won’t be a problem.

He outlined three reasons why he thinks the state should take this step.

“We need coverage in North Carolina for the working poor. Second, there is no fiscal risk for the state budget in the future with this proposal. And, finally, our Medicaid program over the past few years has been reformed and transformed,” he said.

Sen. Joyce Krawiec (R-Forsyth), another longtime critic of Medicaid expansion, called the move “a bailout for hospitals.”

“It’s unlikely that we’ll ever get a better deal than what’s on offer now,” she said.

Many Republicans in the House remain resistant to the idea. House Speaker Tim Moore (R-Cleveland) has not signaled support for putting the measure to a vote during the current legislative session.

Demi Dowdy, spokesperson for Moore, said, “We have been clear with the Governor and our Senate counterparts that Medicaid expansion will only move forward in the House if there are enough votes for a law Project. Many of our members are concerned about a massive expansion of a compensation program at a time of record inflation and economic uncertainty. Attaching controversial and unrelated topics to the expansion doesn’t help the bill’s prospects for this short session.

Asked about the prospect of the House passing the bill, Berger said, “What I’d like us to do is get it through the Senate, get it to the House, and continue the process. education of our colleagues.”

Senate Republicans also include a work requirement with certain exceptions.

The Biden administration opposes Medicaid work requirements and has withdrawn approvals the Trump administration had given to states.

“We’ll worry about getting the bill passed, and then we’ll figure out if it’s something we can convince the Biden administration or convince the courts is the right thing to do,” Berger said.

Republicans also included a variety of other changes dealing with health care access in the bill that go beyond expanding Medicaid. These include provisions aimed at tackling surprise medical billing and transparency, giving nurses greater ability to practice outside of a doctor’s supervision (known as the SAVE Act) and reforms to the certificates of need act and telehealth regulations.

Chip Baggett, CEO of the North Carolina Medical Society, which represents physicians, said his group supports the expansion of Medicaid but is concerned about the inclusion of the SAVE Act provisions.

“The North Carolina Medical Society continues to have significant reservations about the training,” he said. “We believe the inclusion of this is significant harm to this bill and potentially to the state of North Carolina.”

Jordan Roberts, director of government affairs for the conservative John Locke Foundation, said his group still opposes Medicaid expansion but supports other aspects of the bill.

“The state accepting a 10% share threatens the fiscal stability that you have all done so well to control our budget and spending,” he told lawmakers. “If the expansion happens, there could be over 3.3 million people on Medicaid. That’s one in three people in the state. We don’t think it’s a sustainable program.