RALEIGH, N.C. (WGHP) – Medicaid expansion in North Carolina is back on the legislative table, although the people seated at that table might be slightly different.

On Wednesday, state Rep. Donny Lambeth (R-Winston-Salem) filed House Bill 76, which steps away from the legislative approach the House took last summer and offers a different approach to getting Medicaid back to the Senate.

This bill doesn’t appear to include an adjustment to the process for obtaining a certificate of need for new hospitals or allowing greater flexibility for telehealth or expanding the role of nurse practitioners, all of which were sticking points that emerged last June.

State Rep. Donny Lambeth (R-Winston-Salem)
NC House Speaker Tim Moore (R-Cleveland)

Just to reset the situation: Medicaid expansion and the financial windfall that would bring to the state made it halfway to Gov. Roy Cooper’s desk in last year’s session.

Senate Leader Phil Berger (R-Eden) and state Sen. Joyce Krawiec (R-Kernersville) introduced Senate Bill 408, a new version of the old House Bill 149 to expand the Medicaid program under the Affordable Care Act and broaden programs in ways they said they believed would provide greater access to health care in rural counties. That bill passed the Senate with near-unanimous support.

But with the short session winding down, the House said it would not take up that bill and instead passed a proposed adjustment of SB 408 that called for more study of Medicaid expansion, an idea the Senate declined to advance.

After the clock on reaping $1 billion in federal funds ticked down and conversations about compromise were rumored, now we have arrived at the new HB 76 that appears to strip out all that extra stuff and focus on the Medicaid expansion and more federal dollars through the Healthcare Access and Stabilization Program.

“I think it’s a significant step in moving the ball forward because the House will be affirmatively taking action to pass the expansion bill, to do so with the safeguards,” House Speaker Tim Moore (R-Cleveland) told WNCN-Ch. 17.

“Basically it has two parts,” Lambeth said Thursday in response to queries from WGHP. “Medicaid Expansion … and that portion is ONLY about expansion.  No CON [certificate of need], no work requirement and no scope of practice. It is focused only on Medicaid expansion.

“The second part does deal with the additional funds NC can draw from the federal funds as a result of NC going to managed care last year.  I linked these two to demonstrate to my colleagues that funding for expansion will not cost the counties or the state and funding to support expansion. 

“So there are a number of differences from last year’s Senate version which commingled a variety of health policy issues that had nothing to do with expansion. The House Caucus wanted a clean bill if they were going to support expansion.”

The new bill

Lambeth’s new bill has bipartisan support from the get-go, which should help ensure it has a veto-proof majority in the one-vote-decides-that House. He is joined as a primary sponsor by Reps. Donna White (R-Johnston), Michael Wray (D-Halifax) and Chris Humphrey (R-Greene).

But cosponsors include Democratic Reps. Tricia Ann Cotham (D-Mecklenburg), Zach Hawkins (D-Durham) and Garland Pierce (D-Hoke). Triad Republicans John Faircloth (R-High Point), Stephen Ross (R-Alamance) and Wayne Sasser (R-Montgomery) also have signed on among cosponsors.

State Rep. Pricey Harrison (D-Greensboro) told WGHP that she’s not that familiar with details, but that it “appears to be a mostly clean bill.”

It’s unclear how a stripped-down and solo version might be viewed in the Senate. Berger had said in June that he wouldn’t accept the House’s closing proposal then but would “remain open to negotiating with the House.”

State Sen. Joyce Krawiec (R-Kernersville)

Krawiec said in May that her mind also had changed about Medicaid expansion largely because of the components of the bill that would help rural hospitals and the opportunity for coverage in rural areas.

“I’m a long-time opponent, but this is the right time and the right thing,” she said on introducing the bill that passed. “It’s a rescue plan for our hospitals, especially rural hospitals.”

Krawiec’s legislative assistant, Debbie Lown, told WGHP in an email Thursday that “Sen. Krawiec has not reviewed the bill and cannot comment on its substance.”

Association responds

There was an immediate and thorough response, though, from the North Carolina Healthcare Association, a coalition of more than 130 hospitals, health systems and physicians that had opposed the second-level aspects of the Senate’s bill.

“Passing Medicaid expansion and HASP is a bipartisan issue,” Steve Lawler, president and CEO of the association, said in the statement. “Members of all political parties want communities that are healthy and hospital doors that are open. We look forward to continuing to work with members of the General Assembly to make this a good bill that will help hundreds of thousands of our neighbors and that we can all point to with pride.”

The organization notes that its hospitals could achieve up to $1.8 billion under HASP to help Medicaid patients. The organization says this should expand coverage further.

We know that’s a popular concept. A poll of likely voters released last month by the American Cancer Society revealed that more than 8 in 10 respondents said that expanding Medicaid is important to them. They also strongly would support that expansion (78.2%).

Those same sentiments carried across the political spectrum, with 95.1% of Democrats, 79.3% of unaffiliated voters and 69% of Republicans agreeing.

Said Lambeth last month: “If NC adopts Medicaid expansion, that in itself will be a major stretch goal. One that just a few years ago it was viewed as a NO WAY that NC will accept a new Medicaid plan.”