More telehealth, broadband, and Medicaid expansion discussions in the next legislative session

Published December 10, 2020

By Lynn Bonner

A forum on health care policies in the next legislative session showed agreement on the popularity of telehealth, concerns about lack of access to broadband, and disagreement over Medicaid expansion in the North Carolina.

 Rep. Gale Adcock
People like medical appointments by video, a practice expanded in the coronavirus pandemic when government and private insurers agreed to pay medical providers the same as if they were seeing patients in their offices.

The popularity of telemedicine will likely continue after the fear of spreading the coronavirus infection in medical offices passes, said legislators and lobbyists at a Wednesday afternoon online forum hosted by The Insider. The NC Healthcare Association sponsored it.

“Patients have come to expect to be able to come get certain services through telehealth,” said Rep. Gale Adcock, a Cary Democrat and member of the House Health Committee. But telehealth further exposes inequities in broadband availability, she said.

Insurers saw telemedicine visits double with parity in payments, said Tom Fetzer, a lobbyist whose clients this year include Blue Cross Blue Shield of North Carolina and WakeMed Health and Hospitals.

“This is obviously a new tier of service customers are going to demand,” he said. Telemedicine can both increase access to health care and drive down costs, Fetzer said.

Sue Ann Forrest, a lobbyist with the NC Medical Society, said doctors want patients to continue to be able to use telehealth, but want to know how telemedicine visits will be reimbursed.

 Sen. Joyce Kraweic
Sen. Joyce Kraweic, a Forsyth Republican and Senate Health Care Committee chairwoman, praised a state grant program that expanded broadband in rural counties.

Support for telemedicine and small businesses were points of agreement during the forum, but it also revealed lingering differences on Medicaid expansion.

Kraweic said next year is not the time to consider Medicaid expansion because the state is set to start switching from fee-for-service payments to Medicaid managed care.

Kraweic said she was considering targeted Medicaid expansion for new mothers or mothers in substance abuse treatment.

Low-income women without insurance who meet income guidelines are eligible for Medicaid when they become pregnant, but the insurance coverage ends two months after they give birth. There are efforts in North Carolina and nationally to have coverage last for a year.

Adcock said she and other House members continue to be interested in getting more people health insurance.

A Kaiser Family Foundation analysis of the American Community Survey found that  13.6% of nonelderly adults in the North Carolina didn’t have health insurance last year,  the 7th highest rate in the nation.

North Carolina is one of a dozen states that has not adopted Medicaid expansion, according to the Kaiser Family Foundation.

Adcock said hospitals, especially rural hospitals, and people who need medical care need the state to find a way to get more people insured.

Forrest said there’s a great opportunity to work on a compromise, and some have already been proposed.

“Our members feel strongly and the data shows more insurance access and more insurance coverage leads to better health outcomes,” she said.

Fetzer said the state might have “had some movement” on expanded health coverage if Gov. Roy Cooper hadn’t vetoed budgets in his insistence in getting a version of Medicaid expansion that he wanted.

Cooper, a Democrat, was not able to get Medicaid expansion through the Republican-controlled legislature in his first term.

 Lobbyist Tom Fetzer
Fetzer, a Republican, said GOP resistance to expansion is based on their previous experience with rising Medicaid costs. “I think they’re willing to have a conversation,” he said, but the state has to figure out a way to expand coverage while controlling costs.

A group called the North Carolina Council for Health Coverage has started meeting to consider ways to get health insurance to more people. Members include hospital administrators, business people, expansion supporters and opponents, including Kraweic.

In an email, a spokesman for Cooper said the Council is an example of a positive step toward compromise.

“The Governor hopes and believes there are many issues where he and the legislature can agree and he will work hard to find consensus in those areas like health care, education, taxes, criminal justice and the budget,” the statement said.  “The hard work of building consensus takes honest give and take and that positive step is already occurring with leaders of both parties joining the Governor as members of the N.C. Council for Health Coverage where these issues are being discussed.”