RALEIGH, N.C. (WGHP) – With overwhelming speed the North Carolina House again has made its point about expanding Medicaid, and now it’s the Senate’s turn to serve.
Just a week after it was introduced, House Bill 76 was slammed home Wednesday in two quick readings, with three amendments added in the process, meaning the idea of broadening health care to at least a half-million residents is once again a shuttlecock in the legislative game of badminton.
State Rep. Donny Lambeth (R-Winston-Salem), a retired hospital administrator, on Feb. 8 filed HB 76, which is a much leaner approach to Medicaid expansion than the Senate approved last summer and the House ignored. The final vote on the third reading Thursday morning was 92-22.
“This is a part of history,” Lambeth said before that vote. “We need to move this forward so we can begin serious discussions with the Senate to make this happen for North Carolinians.”
HB 76 had wide bipartisan support on second reading, 96-23, even after adding amendments for a work requirement – if one were to be adopted by Congress – $50 million to help counties with their expenses for verifying Medicaid roles and $14 million in tuition reimbursement for nursing students who agree to work in underserved rural areas. Both those expenses are non-recurring.
How the Senate may review this bill remains to be seen. HB 76 strips out the sometimes controversial elements, such as adjusting the process for obtaining a certificate of need for new hospitals, creating greater flexibility for telehealth or expanding the role of nurse practitioners, all of which were sticking points that emerged last June.
“This bill would extend coverage to hundreds of thousands of hard-working North Carolinians for which healthcare is still too costly for them to afford,” House Speaker Tim Moore said in a statement released after the vote. This legislation also addresses the pressing mental health and behavioral health concerns in our state, using federal dollars already allocated for this purpose.
“We have a unique opportunity to expand coverage with federal funds already on the table. The stakes are high and the cost to the state is minimal. Finally, hundreds of thousands of North Carolinians who have been getting by without healthcare coverage will have the peace of mind that an injury or illness will not cost them their livelihood.”
Medicaid expansion, pushed by Democrats since the passage of the Affordable Care Act more than a decade ago, is popular. A poll last week by Meredith College found that 70.3% of residents support Medicaid expansion. That support is at least 6 in 10 across every demographic and ideological measurement.
When last we left Medicaid expansion, the federal subsidy and the financial windfall it would bring had made it halfway to Gov. Roy Cooper’s desk.
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 Medicaid under the Affordable Care Act and adding programs they believed would provide greater access to health care in rural counties. That bill passed the Senate with near-unanimous support.
The House during the last days of that session 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.
HB 76 has two parts, Lambeth said last week. “Medicaid Expansion … and that portion is ONLY about expansion,” Lambeth said. “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 bill had bipartisan support from the beginning. Reps. Donna White (R-Johnston), Michael Wray (D-Halifax) and Chris Humphrey (R-Greene) were primary sponsors.
Cosponsors included 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 signed on among cosponsors.
It’s unclear how this stripped-down and solo version might be viewed in the Senate. Berger has been open to compromise, he said, but in recent days he has expressed concern about the parts of the Senate’s bill not being included. “It’s not the bill we need,” Berger said last week.
But there was support 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 [Healthcare Access and Stabilization Program] is a bipartisan issue,” Steve Lawler, president and CEO of the association, said in the statement.
The organization notes that its hospitals could achieve up to $1.8 billion under HASP to help Medicaid patients, which should expand coverage further.
