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RALEIGH, N.C. (WGHP) — Saying “this is the right thing to do” and that he believes “the Affordable Care Act is not going away,” North Carolina Senate Leader Phil Berger ended years of opposition and, on Wednesday, proposed a bill that would expand Medicaid and offer health care coverage to perhaps a half-million or more residents.

State Senate Leader Phil Berger (R-Eden) (Courtesy of NC General Assembly)
State Senate Leader Phil Berger (R-Eden) (Courtesy of NC General Assembly)

Berger (R-Eden) said he had changed his mind after years of vocally blocking expansion available to states under the federal Affordable Care Act and said he now believes that the time is right and that he has been convinced that the federal government will continue to support the 90% reimbursement program.

“If there is a person in North Carolina who has spoken out against Medicaid expansion more than I have, I’d like to meet that person,” Berger said during a press briefing. “I’d like to talk about why my view has changed. This is the right time and the right thing to do.”

State Sen. Joyce Krawiec (R-Kernersville), one of the principal authors of this bill, said her mind also had changed largely because of the way the components of the bill would help rural hospitals and the opportunity for coverage in rural areas.

Sen. Joyce Krawiec

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

The complex bill also would address and expand the role of nurse practitioners, amend the certificate-of-need process for new hospitals and medical facilities and allow for a more effective financial structure for facilities in rural areas. It also would be cost-effective for the state, Berger said.

He cited figures in a study by WalletHub that ranked North Carolina 49th in health care cost, 43rd in access, 45th in outcomes and 47th overall. He said health care costs were rising much more quickly than in other financial sectors.

“We have to do something to expand health care. … We need coverage for the working poor,” he said.

“I applaud the effort to move forward and provide health coverage for 600,000 working people in our state; something I have worked towards for 12 years,” state Sen. Gladys Robinson (D-Greensboro) told WGHP.

“It is a great next step that the Senate now recognizes the tremendous benefits to NC of Expansion,” state Rep. Donny Lambeth (R-Winston-Salem) wrote in an email to WGHP. “I applaud them for taking up this issue and being proactive. “

Will this become law?

The Senate’s proposal, though, doesn’t mean that Medicaid expansion will happen this year or even to the extent that senators are proposing. This bill is an amendment to House Bill 149, which Lambert cosponsored, but the House assigned that bill to committee and has not been actively pursuing expansion. Even if this bill were to move across to the House, that doesn’t mean it will get full consideration in this short session.

“I’ve talked to the speaker (House Speaker Tim Moore),” Berger said, “and we’ll see what happens. We will send this bill over to them and see what they do with that.”

He also said he had told Moore and Gov. Roy Cooper during budget discussions last year that he would be open to Medicaid expansion. He said the governor’s office had been briefed and had a copy of this bill.

“I am confident the governor will support many parts of the bill,” he said. “I’m hopeful he will e supportive of the bill as a whole. The goal is to pass it in the Senate and get a bill with the House.”

“Expanding health care access to 600,000 of our fellow North Carolinians is not only the correct moral step for our state to take, but also good public health and sound economic policy too,” state Sen. Michael Garrett (D-Greensboro) wrote in an email to WGHP. “While our friends and neighbors continue to see rising healthcare costs, expansion will help bring costs down. I am cautiously optimistic about these first steps and look forward to the legislative journey ahead.”

‘Good fiscal policy’

Before this bill, Berger said he had “concern the federal government would break its promise to pay 90% of the cost. Medicaid was a broken program. It was mismanaged. Republican leadership in General Assembly has turned Medicaid around. We have had eight straight years of no cost overruns.“The Affordable Care Act is not going to go away. All legal and legislative attempts have not succeeded, and I don’t think that’s going to change. And I think it’s likely the 90% reimbursement will continue.”

He cited a 2-year infusion of $1.5 billion into the state’s coffers and said that “Medicaid expansion has evolved to the point where it is good state fiscal policy.”

Officials said they didn’t know if this would affect 500,000 or 600,000. They cited about 300,000 they think are on Medicaid rolls illegally and can’t be removed because of COVID-19 rules.

The bill does have a work requirement, Berger said, which may not pass muster with federal law. He said the requirement is “something I’d like to see. Our goal is to get this passed and see if we can persuade the Biden administration and the courts.”

The bill also specifies that the Department of Health & Human Services secretary can end expansion at any point when costs aren’t covered, Krawiec said.

“If federal government pulls out of 90% reimbursement rate, we will step out. We don’t believe that will happen,” she said.

Addressing patients

But Berger and Krawiec stressed that this bill is about patients.

“The case I always think about and talk about in this context is a single mother who is working full time … has 2 or 3 children, children covered by Medicaid. She is not covered. She does not have other health care options. She had difficult choices. She pays for food, clothing, shelter. … It’s a logical choice not to pay $600, $700 or $800 a month for policy just for her. … She ends up in the emergency room,” Berger said.

“Those are the people we need to help, and those are people this bill will help.”

Krawiec said this bill would provide health care access of $600 million minimum to hospitals. It expands Medicaid and telehealth services.

“Those are three things our hospitals have been telling us they most wanted,” she said. “This bill pairs with other actions to improve care.”

She said the bill would provide medical billing transparency so that no one is surprised by a cost on a bill. She, Berger and others talked about how the expansion of roles of nurse practitioners to work without a supervisor present can expand coverage, too.

“We are losing providers at every level of health care in the state,” Sen Ralph Hise (R-Watauga) said. “Finding doctors and nurses is becoming more and more impossible. The bill allowing the nursing profession to expand this scope will help.”

Certificates of need

Berger said the bill would change the market analysis that is conducted by the DHHS to determine what facilities might be needed. “I’ve never had confidence in the ability of government regulators to assess what market needs,” he said. “DHHS will look at quality.”

The bill also would eliminate a certificate of need for determining whether psych beds, substance abuse facilities, MRIs and surgical centers could be expanded in a specific area.

Future plan

A committee of senators and representatives has been working on a joint proposal to outline how Medicaid and health care coverage might expand. Krawiec and Lambeth have chaired that committee. Krawiec said she and Lambeth agreed this bill was the right thing to do.

“We’re likely not going to be here when the committee comes up with its recommendation,” Berger said. “I fully expect recommendation would be, if not identical, similar to this bill.”