RALEIGH, N.C. (WGHP) – North Carolina Rep. Donny Lambeth (R-Winston-Salem) convened the House Health Committee on Thursday to consider Medicaid expansion in a way that he said in the meeting would help rural health care.

That had been Lambeth’s plan last year, when he helped author a bill that the Senate ultimately passed with some changes earlier this month. But on Thursday House Bill 149 was gone, replaced by a new 12-page plan the House calls the “Rural Healthcare Access & Savings Plan Act,” Senate Bill 408.

State Rep. Donny Lambeth

Lambeth had told WGHP on Wednesday night that his committee would “have an option for committee discussions only that might be a reasonable compromise to keep the interest level active as members in the House look for a pathway to expand Medicaid and Medicaid only without some of the other items in the Senate bill.”

But several items in the Senate bill, written to address expanding health care coverage in rural areas and touted by Lambeth’s colleague, state Sen. Joyce Krawiec (R-Kernersville), a sponsor of the Senate’s bill, are not part of the House’s plans.

Apparently, House Speaker Tim Moore (R-Cleveland), who had said the House didn’t have much “appetite” for Medicaid expansion, told The News & Observer of Raleigh that he and Health and Human Services Secretary Kody Kinsley had been working on this new bill for weeks.

Senate Bill 408 does include a hospital reimbursement schedule, a workforce development plan and a work requirement to participate in Medicaid.

Senate Bill 408 by FOX8 on Scribd

But that bill doesn’t appear close to a vote. Moore appears to have tied the expansion to a vote on a new 2-year budget, which he and Senate Leader Phil Berger (R-Eden) have said repeatedly is the primary goal for this short session. Those talks, too, have stalled. The two reportedly met for about 20 minutes on Thursday morning.

On Wednesday night, Berger had told reporters that “so, the House has gone from ‘No,’ to ‘Let’s study it again.’ Remember, we authorized a study in last year’s budget. It is past time for action. The House should pass the Senate version of House Bill 149, or we should agree to incorporate it into the budget.”

Berger never had never been much of a supporter for expanding Medicaid, which was made available under the Affordable Care Act and would pay for coverage for perhaps a half-million uninsured North Carolinians and provide $1.5 billion to the state. North Carolina is one of 12 states that have not accepted the plan.

Senate Leader Phil Berger

The issue had been debated for years, with Gov. Roy Cooper, a Democrat, supporting the expansion – as have most Democrats in the General Assembly – but Berger and Moore against the idea. They started to warm to the concept last year and have discussed their plans with Cooper.

He said last month that he had changed his mind 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.”

Officials have 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.

Both the House and Senate would like a work-requirement clause in the plan, but the Biden administration is opposed to that concept, and the courts have not judged it to be legal.

House Speaker Tim Moore (NCGA)

Krawiec touted her bill because it provided money for rural hospitals, expanded telehealth programs, restructured oversight to so-called “certificates of needs” for new medical facilities and expanded the capabilities of nurse practitioners to treat patients.

But the House bill would remove those pieces, and it also would require further study.

The News & Observer said that Moore said that he won’t call for a floor vote unless there is more support for this bill other than Republicans, whose support is related to the federal funds. “If there wasn’t the $1.5 billion, I’d say there would be less support for it,” Moore told the N&O. said.

House Democrats long have sought expansion.