Medicaid expansion may come to North Carolina, but it won’t be quite what supporters want it to be.
A Republican compromise version of Medicaid expansion moved forward in a House committee Tuesday with bipartisan support. And Democratic Gov. Roy Cooper rolled out his own budget compromise at the same time. But more than a week into the new fiscal year with no spending plan in place, the GOP-controlled legislature and Cooper remain at an impasse.
The compromise bill heard in House committee, called “NC Health Care for Working Families,” is a type of Medicaid expansion, said House Speaker Tim Moore on Monday. It’s not the full expansion that Cooper wants, and it includes work requirements.
Rep. Donny Lambeth, a Winston-Salem Republican, calls it an alternative option that “might fit North Carolina’s culture.” Lambeth said it would serve 300,000 North Carolinians who currently have no health insurance, and up to 500,000 total if everyone eligible uses it.
The work requirement is a key difference between this and Cooper’s Medicaid expansion. Participants’ costs would be 2% of their household income, billed monthly. It would cover those residents who meet all federal Medicaid citizenship and immigration requirements and are not eligible for Medicaid under the current program.
Other requirements include: Their modified adjusted gross income is not higher than 133% of the federal poverty level; they are not entitled to or enrolled in Medicare Part A or B; and they are between the ages of 19 and 64.
The House Health Committee voted 25-6 in favor of the bill. Later Tuesday, it was fast-tracked to the agenda for the full House. If approved there, it would still have to go through the Senate, where leaders have been opposed to the idea.
What Gov. Cooper says
Tuesday, Cooper called the health bill discussion a good step forward.
“Clearly, if they’re discussing it, they realize that it’s an important part of this process, but it has to go through two chambers in order to pass, and I’ll leave it at that,” Cooper said during a news conference rolling out the new budget compromise.
No changes were made to his Medicaid expansion push from his previous proposal. Cooper’s Medicaid expansion does not include work requirements or premiums.
“I would rather have a pure Medicaid expansion, and here’s why,” Cooper said. “It costs more to enforce premiums and work requirements than it’s worth. We’ve seen it in other states, and in addition, most of the people we’re talking about, the vast majority of people are already working, but those are items that can be discussed as we continue to negotiate this budget.”
The Republican Medicaid compromise
In the Republican compromise, Lambeth said the benefit structure is tied to wellness and preventative care with patients being assigned a primary care provider.
“A lot of people don’t take care of their selves even if they have health insurance,” Lambeth said. “They don’t like going to the doctor. ... You’ve got to participate in the program. You‘ve got to go to your screenings. Personally I hate going to those.”
Preventative care would help teachers at childcare centers, said Cassandra Brooks, who spoke in favor of the bill. Brooks owns childcare centers in Wake Forest and Johnston County, she said, where “hardworking teachers cannot afford health insurance.”
Brooks said one teacher who died had high blood pressure that led to a heart attack, which she said may have been prevented with earlier doctor visits.
Erica Palmer Smith, director of Care4Carolina, spoke in favor of the bill, saying it would help close the coverage gap. She said small business owners, restaurant workers, veterans and fishermen are among those who lack health insurance in the state.
Care4Carolina is a part of the American Heart Association and lists support by dozens of groups, including NC Child, AARP, Duke Health System, North Carolina Healthcare Association and the National Alliance on Mental Illness-North Carolina.
Critics of the plan
Rebecca Cerese of the N.C. Justice Center, a left-leaning advocacy group, said while the group is grateful for the new proposal, it can’t endorse it in its current form.
The bill “will create new barriers to health care for those it aims to help,” she said. The 2%-of-income premium is a lot for some families and will force people to choose between health care and putting food on the table, she said.
“The work requirements in this bill are completely unnecessary and fiscally irresponsible,” Cerese said.
The right-leaning Civitas Institute doesn’t like the bill, either.
Civitas Institute President Donald Bryson said the group is concerned about the federal deficit, though Lambeth said he doesn’t think the plan would increase it.
“Any new spending will add to deficit and debt,” Bryson said. He said hearing about taxes paying for it doesn’t make him feel great as a fiscal conservative.
Conservative opposition could make the plan a tough sell in the state Senate, too.
“I don’t see where the votes exist to pass Medicaid expansion in the Senate,” Senate leader Phil Berger said.
Berger criticized Cooper as being unwilling to separate the issues of the budget and Medicaid: “I think as long as the governor insists as Medicaid expansion as the first step before we can talk about the other things, I don’t think his proposals are serious.”
Rural health care
The bill also provides grants for rural access to health care. It would create a special fund in the Department of Health and Human Services with money from General Assembly appropriations, gifts, grants and donations from both the public and private sectors. It would have $25 million in 2020-21 fiscal year, then $30 million in 2021-22 and $50 million every year after that.
No single grant would be greater than $1 million, and it could be used for technology upgrades in rural hospitals.
“Remember rural health care is just going to get worse if we do nothing,” Lambeth said.
George Little of Southern Pines, a former Republican candidate for governor, called the bill “a common-sense conservative solution.” He said healthy communities are “essential for vibrant rural economies.”
Becki Gray of the right-leaning John Locke Foundation think tank said lawmakers are looking at the wrong problem. She said they need to look at lowering the cost of health care so people can afford the health insurance they want to buy.
Rep. Donna McDowell White, a Clayton Republican and one of the bill’s sponsors, said it would allow the working poor to have an option to purchase their own insurance.
Rep. Verla Insko, a Chapel Hill Democrat, said she likes a lot about the bill, especially preventative care. But she said she has concerns about the administrative costs of collecting premiums.
Cooper budget compromise
Cooper rolled out several proposals in a budget counter offer Tuesday, including restoring master’s degree pay for teachers. A raise for teachers with advanced degrees was in Cooper’s original budget but not in the legislature’s budget.
Other items in Cooper’s new proposal:
▪ Increase teacher pay by an average of 8.5% over two years.
▪ Higher state employee pay raises: 5% raises for state employees, 5% for non-certified school personnel, 5% for UNC employees and 4% for community college employees.
▪ 2% cost of living adjustment for retired state employees.
▪ Keep private school vouchers but do not increase funding.
▪ Instead of moving the Department of Health and Human Services from Dix Park in Raleigh to Granville County, as in the conference budget, study the best place to relocate the headquarters.