Republican-led Senate in NC gives preliminary approval to Medicaid expansion after years of fighting it

The Republican-led Senate gave preliminary approval to a bill that would expand Medicaid coverage to adults who are currently ineligible for the government health insurance. The vote marks a significant milestone for a chamber whose leaders for about a decade fought expanding the health coverage by threatening a lawsuit, criticizing expansion in newspaper opinion pages, and passing a law to block it.

Democrats in the state have been pushing for Medicaid expansion for years. North Carolina is one of a dozen states that has not expanded Medicaid.

“It does my heart good that even though it took 10 years, you all are there,” Sen. Gladys Robinson, a Guilford County Democrat, said during Wednesday’s debate. “Praise the Lord.”

Even with the Senate vote, there’s no guarantee that expansion will become law. House Speaker Tim Moore, a Kings Mountain Republican, told reporters last week that the House would not consider Medicaid expansion in this legislative session, the Associated Press reported.

Senate Leader Phil Berger, an Eden Republican who was a vocal opponent of expansion,  offered a host of reasons for his changed views, NC Policy Watch has reported. As the Senate moved toward its 44-2 vote, Berger told senators, “Quite frankly, our work has just begun. For this to become law, there are 120 people on the other side of the building that we’ve got to start working on.”

A 2012 U.S. Supreme Court decision on the Affordable Care Act upheld most of the law but said that expanding Medicaid was optional for states. That left most low-income adults in North Carolina who don’t have dependent children caught in something called the health insurance gap. They make too much money to qualify for Medicaid and too little to qualify for subsidized insurance coverage available through health insurance marketplaces. Parents with children at home must have very low incomes to qualify for Medicaid.

About 2.7 million North Carolinians are now enrolled in Medicaid. Most are children. The federal government pays more than two-thirds of North Carolina’s Medicaid costs.

For people who enroll under expanded Medicaid, the federal government covers 90% of the cost. Under the bill, hospitals would pay the other 10%. The bill’s authors said the bill sets it up so the hospitals will get that money back from the federal government. Additionally, the federal government is offering financial incentives to states that have not expanded Medicaid, which for North Carolina would mean an additional $1.5 billion over two years.

“Medicaid expansion has evolved to a point that it is good state fiscal policy,” Berger said. “We will not get a better deal to expand Medicaid than we have right now.”

Estimates of how many North Carolinians would be eligible for Medicaid under expansion range from about 200,000 to 600,000. The coalition Care4Carolina, which for years has been trying to get the state to expand Medicaid, estimates that about 600,000 people are in the coverage gap. Many of those adults work at jobs that don’t offer insurance.

“The Senate’s action today is a major step toward helping hundreds of thousands of North Carolinians who are currently in the gap, including working parents, small businesses across the state and 14,000 of our veterans,” the coalition said in a statement. “Closing the coverage gap by expanding Medicaid will improve the health of our people, our economy and our entire health care system.”

NC Senate leader Phil Berger

Rolled up in the bill are changes to the Certificate of Need law, under which the state determines whether a new medical facility or expensive piece of medical equipment is needed in an area, and a change that allows nurses with advanced degrees to practice independent of doctors’ supervision. The legislature has debated both these issues for years. Hospitals oppose changing the Certificate of Need law, and doctors don’t want to change the law requiring advanced practice nurses to have doctor supervisors.

“This bill addresses both demand side and supply side health care reforms,” said Sen. Ralph Hise, a Spruce Pine Republican.

Sen. Mike Woodard, a Durham Democrat, said Medicaid expansion would be good for the economy and rural health care. With insurance, thousands of people who don’t now receive preventative care would be able to get it.

“Yes, it’s about cost and access,” Woodard said. “But in the end, remember this bill is about better outcomes.”