Breakthrough Medicaid Expansion Within Reach in N. Carolina

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RALEIGH, NC (TBEN) — After a decade of strong opposition, most Republicans in North Carolina have now embraced the idea of ​​expanding the state’s Medicaid program to cover hundreds of thousands of additional low-income adults. Legislative approval finally seems within reach.

At 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 still need to be worked out, but there is a real chance of reaching a compromise by the end of the year.

It’s a remarkable political turnaround in North Carolina, sure to be analyzed in the dozens of states that have the federal government’s offer to cover people who earn too much to be covered by traditional Medicaid but too little to get a subsidized one. to receive private insurance, have yet to accept.

“If there’s one person in the state of North Carolina who has spoken out more against the expansion of Medicaid than I have, I’d love to meet that person,” Senate Leader Phil Berger said as he tried to explain his turnaround at a news conference in May. . “We need coverage in North Carolina for the working poor.”

The two chambers failed to resolve their disagreements before adjourning, and talks between legislative leaders and Democratic administration Roy Cooper — a longtime proponent of expansion — have stalled ever since, in a deadlock over other health care reforms senators are seeking. . But Berger remains optimistic about the eventual success. “I think we’ll get there,” he recently told reporters.

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“There is a lot of work that needs to be done…but overall we feel tremendously encouraged by how far we have come,” said Erica Palmer Smith, executive director of Care4Carolina, a coalition of 150 groups that has worked for expansion since 2014.

Other lawyers are tired of waiting. They say too many working poor are uninsured, putting their health and life at risk. Others on traditional Medicaid worry that they will no longer be covered without extension if they make too much money.

“I don’t know what to do,” said Courtney Crudup, 32, of Oxford, a mother of three and a beautician who is currently unemployed. She spoke outside the Legislative Building this week at an event that urged lawmakers to take action. “Listen to our stories. Hear ordinary people like me and people who want to work.”

The apparent change of heart followed years of GOP suspicion over the 2010 Affordable Care Act, which Republicans derided as “Obamacare,” only to see the label, as well as the program, become very popular.

For years, Republicans said they couldn’t trust Congress to keep the federal government’s promise to pay 90% of the expansion costs. They said the state’s Medicaid program — now with 2.7 million enrollees — had spent years overspending and was unprepared to take on more.

And essentially they argued that more people would become dependent on the government if they took advantage of Medicaid, which now mainly serves poor children and their parents and the elderly on low incomes.

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Republicans say Medicaid spending in North Carolina is now largely under control, and they don’t think Congress will increase the state’s share of the cost by more than 10%. The state’s portion — perhaps as much as $600 million a year — can be covered by assessments of the state’s hospitals and insurance plans.

Interest also grew as the 2021 federal aid package COVID-19 provided a financial sweetener to encourage the remaining states to accept expansion. For North Carolina, whose tax coffers are already up to scratch thanks to a roaring economy, it would be an additional $1.5 billion in two years.

“This is an opportunity to take federal dollars, actually provide savings to the state of North Carolina and increase access to health care,” House Speaker Tim Moore told colleagues in June. “I’d call that a pretty good trifecta to do those things.”

Cooper can also take credit for his perseverance. He has pushed for expansion nonstop since taking office in 2017, citing the economic shot in the arm that federal money would bring to rural hospitals, communities and families of the 600,000 residents who could qualify.

Cooper went so far as to veto the 2019 state budget because Moore and Berger would not commit to Medicaid talks. He signed this year, saying “we are closer than ever to an agreement on expanding Medicaid,” and a veto “would be counterproductive.”

A pivotal moment came after the 2020 election, when Cooper convened a bipartisan committee of medical, business and nonprofit leaders and state lawmakers who came up with “guiding principles” to improve health coverage.

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“People with very different political views were willing to listen to those who come up with these issues from different backgrounds and different concerns,” said Mark McClellan, director of the Duke-Margolis Center for Health Policy at Duke University, who convened the committee. .

Another influencer was former Ohio governor John Kasich, who in March told a joint House and Senate committee how expansion has worked in his Republican state. The committee focused on the details, including how to increase the number of nurses, hospital beds and services in the state.

Negotiations between the House, Senate and Cooper were delayed this summer, mainly because the Senate wants regulatory changes aimed at providing even more access to services, which he says will lower costs.

They include giving nurse practitioners, certified midwives and others the ability to work independently of physicians, and scaling back “certificate of need” laws that critics say allow medical providers to limit competition that would reduce their revenues. can decrease.

Berger accuses hospitals of refusing to accept a compromise. The North Carolina Healthcare Association, which represents hospitals and health systems, said it is concerned about Berger’s bill but remains in favor of expanding.

“It’s positive that both chambers now support expansion, and right now hospitals hold the key to making this happen,” said Cooper spokesman Ford Porter.

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