RALEIGH, NC — After a decade of staunch opposition, most North Carolina Republicans have now embraced the idea of expanding the state’s Medicaid program to cover hundreds of thousands more low-income adults. Legislative approval finally seems possible.
During the General Assembly session that ended July 1, the GOP-controlled House and Senate passed separate, bipartisan measures by wide margins that would put the state on the path to Medicaid expansion. Some details remain to be worked out, but there is a real chance to reach a compromise by the end of the year.
It’s a remarkable policy shift in North Carolina that will surely be analyzed in the dozens of states that have yet to accept the federal government’s offer to cover people who make too much to be covered by traditional Medicaid but too little to get subsidized private insurance.
“If there’s one person in the state of North Carolina who has been more vocal against Medicaid expansion than I have, I’d like to know them,” Senate Majority Leader Phil Berger said when he tried to explain his reversal at a May news conference. “We need coverage in North Carolina for the working poor.”
The two chambers were unable to resolve their differences before the shutdown, and talks between legislative leaders and Democratic Gov. Roy Cooper — a longtime supporter of the expansion — have stalled since then, deadlocked on other health care reforms they are pursuing. the senators. But Berger remains bullish on eventual success. “I think we’ll get there,” he told reporters recently.
“There’s a lot of work to be done … but overall we feel extremely encouraged by how far we’ve come,” said Erica Palmer Smith, executive director of Care4Carolina, a coalition of 150 groups that has worked on expansion since 2014.
Other advocates are tired of waiting. They say too many of the working poor are uninsured, putting their health and lives at risk. Others on traditional Medicaid worry that without expansion, they will no longer be covered if they make too much money.
“I don’t know what to do,” said Courtney Crudup, 32, of Oxford, a mother of three and cosmetologist who is currently unemployed. He spoke this week outside the Legislature at an event urging lawmakers to act. “Listen to our stories. Regularly listen to people like me and people who want to work.”
The apparent change of heart followed years of GOP suspicion of the 2010 Affordable Care Act, which Republicans derided as “Obamacare” only to see the label, as well as the program, become wildly popular.
For years, Republicans said they couldn’t trust Congress to honor the federal government’s promise to pay 90 percent of the expansion’s costs. They said the state’s Medicaid program — now with 2.7 million enrollees — had been overspending for years and ill-prepared to take on more.
And basically, they argued that more people would become dependent on the government if they were allowed to take advantage of Medicaid, which now primarily serves poor children and their parents and low-income seniors.
Republicans say North Carolina’s Medicaid spending is now largely under control and don’t believe Congress will increase the state’s share of the cost beyond 10 percent. The state’s share—perhaps as much as $600 million a year—can be covered by assessments on state hospitals and insurance programs.
Interest also grew when the 2021 federal COVID-19 aid package offered a financial sweetener to encourage other states to accept the expansion. For North Carolina, whose tax coffers are already drained thanks to a roaring economy, it would be an additional $1.5 billion over two years.
“This is an opportunity to take federal dollars, really show a savings to the state of North Carolina and increase access to health care,” House Speaker Tim Moore told colleagues in June. “I’d call it a pretty good trifecta to do those things.”
Cooper can also take credit for his persistence. He has pushed relentlessly for an expansion since taking office in 2017, citing the economic boost the federal money would bring to rural hospitals, communities and the 600,000 families who could qualify.
Cooper went so far as to veto the 2019 state budget because Moore and Berger would not commit to the Medicaid talks. He signed this year’s bill, saying “we are closer than ever to a deal on Medicaid expansion” and a veto “would be counterproductive.”
A pivotal moment came after the 2020 election, when Cooper convened a bipartisan panel of medical, business and nonprofit leaders and state lawmakers that came up with “guiding principles” for improving health care coverage.
“People with very different political views were willing to listen to those coming at these issues from different backgrounds and different concerns,” said Mark McClellan, director of the Duke-Margolis Center for Health Policy at Duke University, which convened the panel.
Another influencer was former Ohio Gov. John Kasich, who told a joint House-Senate committee in March how the expansion worked in his Republican-leaning state. The committee focused on details, including how to increase the number of nurses, hospital beds and services in the state.
Negotiations have slowed this summer between the House, Senate and Cooper, largely because the Senate wants regulatory changes aimed at providing even greater access to services that it says will result in lower costs.
They include allowing nurses, certified nurse midwives and others to work independently of doctors and reducing “certificate of need” laws that critics say allow physician providers to limit competition that could reduce their revenues .
Berger accuses the hospitals of refusing to accept a compromise. The North Carolina Healthcare Association, which represents hospitals and health systems, said it has expressed concerns about Berger’s bill but remains a supporter of the expansion.
“It’s positive that both chambers are now supporting the expansion and right now the hospitals hold the key to making that happen,” said Cooper spokesman Ford Porter.
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North Carolina Republicans have now embraced the idea of expanding the state’s Medicaid program Source link North Carolina Republicans have now embraced the idea of expanding the state’s Medicaid program