Medicaid Expansion Success Within Reach in N. Carolina

Raleigh, NC (AP) — After a decade of vigorous opposition, most North Carolina Republicans have now embraced the idea of ​​expanding the state’s Medicaid program to cover hundreds of thousands of additional low-income adults. Legislative approval finally appears to be within reach.

During the General Assembly session that ended on July 1, the GOP-controlled House and Senate passed separate, bipartisan measures with wide margins that would put the state on the path of Medicaid expansion. Some details are yet to be worked out, but there is a real opportunity for compromise by the end of the year.

It’s a notable political shift in North Carolina, one of the dozen states yet to be analyzed that have yet to accept the federal government’s proposal to cover people who are too high to be insured by traditional Medicaid. , but subsidized private insurance is too low to be obtained.

“If there is anyone in the state of North Carolina who has spoken out more against Medicaid expansion than I do, I want to meet that person,” Senate Leader Phil Berger said as he explained his reversal at a news conference. demanded. May. “We need coverage in North Carolina for the working poor.”

The two houses could not resolve their differences before adjourning, and talks between legislative leaders and Democratic Gov. Roy Cooper – a longtime extension supporter – have since been dormant, over an impasse over other health care reforms that senators want. . But Berger remains optimistic about the eventual success. “I think we’ll get there,” he told reporters recently.

Erica Palmer Smith, executive director of Care4Carolina, said, “A lot of work needs to be done…2014.

Other lawyers are tired of waiting. They say that many of the working poor are uninsured, putting their health and their lives at risk. Others on traditional Medicaid worry that without expansion, if they make too much money they will no longer be covered.

“I don’t know what to do,” said Courtney Crudup, 32, of Oxford, a mother of three children and a cosmetologist who is currently unemployed. He urged MPs to take action at an event outside the Vidhan Bhavan this week. “Listen to our stories. Listen to regular people like me and willing to work.”

The apparent change of heart followed years of GOP skepticism about the Affordable Care Act of 2010, which Republicans ridiculed as “Obamacare” only to see the label, as well as the program becoming overly popular.

For years, Republicans said they could not count on Congress to keep the federal government’s promise to pay 90% of the cost of the expansion. He said the state’s Medicaid program — now with 2.7 million enrollments — had been spending more for years and was unwilling to take on more.

And fundamentally, he argued, allowing more people to benefit from Medicaid would make more people dependent on the government, which now mostly serves poor children and their parents and the elderly with low incomes.

Republicans say North Carolina Medicaid spending is now largely under control and they don’t think Congress will increase the cost of the state’s share by more than 10%. The state’s share — perhaps $600 million annually — may be covered by assessments on state hospitals and insurance plans.

Interest rose even as the 2021 COVID-19 federal relief package offered a financial sweetener to encourage the remaining holdout states to accept the extension. For North Carolina, whose tax coffers are already in place thanks to a roaring economy, that would be an additional $1.5 billion over two years.

“This is an opportunity to take federal dollars, really introduce savings to the state of North Carolina and increase access to health care,” House Speaker Tim Moore told aides in June. “I would say a really cool trifecta for doing those things.”

Cooper can also take credit for his stubbornness. He has pushed nonstop for expansion since taking office in 2017, citing the economic shot in hand that federal funds will bring to rural hospitals, communities and the families of 600,000 residents who may qualify.

Cooper went so far as to veto the 2019 state budget because Moore and Berger would not commit to Medicaid talks. He signed off on this year’s signing, saying, “We are closer than ever to agreement on Medicaid expansion,” and a veto “would be counterproductive.”

A pivotal moment came after the 2020 elections, when Cooper convened a bipartisan commission of medical, business and nonprofit leaders and state legislators to come up with “guiding principles” to improve health care coverage.

Mark McClellan, director of the Duke-Margolis Center for Health Policy at Duke University, said, “People with different political views were more than willing to hear people coming to these issues from different backgrounds and different concerns.”

Another influential figure was former Ohio Governor John Kasich, who in March told a joint House-Senate committee how expansion in his Republican-leaning state had worked. The committee focused on details, including how to increase the number of nurses, hospital beds and services in the state.

Talks between the House, Senate and Cooper slowed this summer, as the Senate wants regulatory changes aimed at providing even greater access to services that would result in lower costs.

These include giving nurse practitioners, certified nurse midwives and others the ability to work independently of doctors, and withdrawing “certificate of need” laws that critics say limit competition to medical providers. enables which can reduce their revenue.

Berger accused the hospitals of refusing to accept the settlement. The North Carolina Healthcare Association, which represents hospitals and health systems, said it has raised concerns about Berger’s bill, but remains an extension advocate.

“It’s positive that both chambers now support the expansion, and right now hospitals hold the key to accomplishing that,” said Cooper spokesman Ford Porter.

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