RALEIGH, N.C. (WGHP) – Whether Medicaid expands in North Carolina is now squarely in the hands of the state House.

The Senate on Thursday passed House Bill 149, the Expanding Access to Healthcare Act, on third reading by a vote of 44-1, meaning the expansion of Medicaid and other steps to broaden access to health care moves back to the House.

House Speaker Tim Moore (R-Cleveland) has said he doesn’t see much “appetite” to take up this bill during the current short legislative session. State Rep. Jon Hardister (R-Whitsett), the House majority whip, said via text message as the House was convening Thursday that “we still are talking it over.”

State Rep. Donny Lambeth (R-Winston-Salem)

State. Rep. Donny Lambeth (R-Winston-Salem) is the original sponsor of the bill and he cited the “good work” of the Senate and his excitement about the passage of the expansion bill.

“I have worked on some variation of an expansion bill for 8 years, so I am pleased that they have finally understood the benefits to NC and our citizens,” he said.  

“However, the House is primarily focused on the budget work, and I don’t believe we will take up the Senate bill in the short session.  One reason is simple: We need to let the committee that was appointed to make a recommendation do just that. 

“The committee has work to do and can possibly use their bill as a framework for discussion.  But I do not believe the House leadership has any plans to take up the Senate bill.” 

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

Senate Leader Phil Berger (R-Eden) said last week that he had turned completely around about expanding Medicaid because of the grave need in North Carolina and because he believed the Medicaid program was fulfilling its promise under the Affordable Care Act and that the ACA “wasn’t going anywhere.”

“I had a concern the federal government would break its promise to pay 90% of the cost,” he said. “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.”

State Sen. Joyce Krawiec (R-Kernersville), a sponsor in the Senate, said she, too, had been skeptical about Medicaid expansion but had seen the light. She also cited the provisions I the bill that helped rural health care.

She said the bill provides health care access of $600 million minimum to our 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.”

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

Specifics of the bill

Based on a release from the Republican caucus, among other things the bill:

  • Expands Medicaid for individuals earning up to 138% of the federal poverty level ($38,295 for a family of four).
  • Establishes a program to invest at least $600 million from the federal government – and potentially as much as $3 billion – to bolster North Carolina hospitals.
  • Requires the 10% state share to be paid for through modernizing the state’s existing hospital assessment in addition to enacting a new one on hospitals.
  • Requires transparency in the form of annual reports from the Department of Health and Human Services on the financials of the program.
  • Gives the DHHS Secretary the ability to end expanded coverage if the state share cannot be covered.
  • Establishes a work requirement to receive expanded coverage, similar to work requirements already in law.
  • Reforms the state’s Certificate of Need laws by creating two separate application pathways.
  • Stops surprise medical bills by requiring healthcare facilities to inform patients if they are scheduled to see out-of-network providers.
  • Requires health insurance providers to cover telehealth services. 
  • Allows advanced practice registered nurses to practice at the top of their license – granting them full practice authority.

The only negative vote on the bill was by Sen. Norman Sanderson (R-District 2), who represents Carteret, Craven and Pamlico counties.

Gov. Roy Cooper has been an advocate for Medicaid expansion, but he has not commented on this specific bill. Berger said he has been briefed.

CORRECTION: An earlier version of this article misstated the last name of House Speaker Tim Moore.