News of a potential compromise on state Medicaid expansion Thursday yielded mostly positive and cautiously optimistic responses from public-health advocates.
North Carolina would become the 40th expansion state if the state House approves of major changes to House Bill 76 that adds several certificate-of-need reforms sought by Senate Republican leaders.
However, there remains some criticism about the potential growth in the Medicaid program amid concerns that the provider network won’t be able to handle the projected additional 450,000 to 650,000 beneficiaries.
Those who might be eligible under an expanded program are those between the ages of 18 and 64 who earn too much to qualify for Medicaid coverage, but not enough to purchase coverage on the private insurance marketplace.
“This is obviously a big announcement and it represents a dramatic change in position for Republican legislative leaders,” said John Dinan, a political science professor at Wake Forest University who is a national expert on state legislatures.
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House speaker Tim Moore, R-Cleveland, cited Thursday the availability in 2022 of the Healthcare Access and Stabilization Program (HASP) as a key element in the expansion pursuit.
According to the N.C. Healthcare Association, HASP would allow “North Carolina hospitals and health systems the opportunity to receive up to $1.8 billion in federal dollars to improve access to care for Medicaid patients.”
Dinan said Berger, Moore and other key Republican legislative leaders were “presumably persuaded to do this now by the promise of a significant amount of additional federal money coming to the state in the next few years as a result of legislation passed in the last Congress.”
Dinan said he would reserve judgment on HB76’s chances of clearing the House with the inserted CON reforms.
“That is the next thing I will be poring over the details for,” Dinan said.
NCHA on board
The N.C. Healthcare Association has been among the chief prodders of Republican legislative leaders and Democratic Gov. Roy Cooper reaching a Medicaid expansion agreement.
That includes Steve Lawler, NCHA’s president and chief executive, who in August called out Cooper, Berger and Moore for being willing to let Medicaid expansion “die because you are looking for a deal.”
At that time, the NCHA, as well as the N.C. Medical Society and the Old North State Medical Society, strongly opposed the Senate’s CON reform priorities and preferred the House version because it has a much lower financial and regulatory impact on health-care systems and hospitals.
Lawler stressed in his letter that NCHA members “are not elected to office, and therefore we are not the ones standing in the way of passing legislation. That burden, and opportunity, lies with your branches of government.”
On Thursday, Lawler praised Berger and Moore and Democratic legislative leaders on reaching an agreement to support expansion legislation, particularly the HASP component.
“Members of all political parties want communities that are healthy and hospital doors that are open,” Lawler said.
“This legislation will go far to strengthen the health of people in our state and to support maintaining access to health care, especially in rural communities.”
“We look forward to working with elected officials to support getting this historic legislation passed into law soon.”
Mixed views
The conservative think tank John Locke Foundation — as expected — vigorously opposed the Medicaid expansion compromise agreement.
The foundation claims the state’s health-care network and economy will be hurt by expansion, citing the additional 450,000 to 650,000 beneficiaries.
It had stated concerns that expanding Medicaid will remove eligible individuals from private insurance on the federal health insurance exchange, and shrink access to care for current Medicaid recipients if the provider network is not increased substantially.
“The announcement by the legislative leadership is disappointing,” said Donald Bryson, the foundation’s president.
“The largest expansion of entitlements in state history is about to take place under Republican control of the General Assembly. The move is even more perplexing when you consider that most states that have expanded have had significant cost overruns on expansion beyond projections.
“These overruns put pressure in several budget areas, including education and public safety,” Bryson said. “Republican assertions that expansion will end if it becomes fiscally untenable is a pipe dream.”
Among the more vocal public-health advocacy groups for Medicaid expansion has been the 166-member Care4Carolina coalition.
“The announcement is a giant step toward making affordable health-care accessible to hundreds of thousands of North Carolinians who are currently in the health-care coverage gap, including working parents, small businesses and 14,000 of our veterans,” said Abby Emanuelson, the coalition’s executive director.
“Expanding Medicaid will improve the health of our people, our economy and our entire health care system.”
Proponents
The American Cancer Society Cancer Action Network said expanding Medicaid will give “thousands of North Carolinians a fighting chance against the state’s leading cause of death with the health coverage they need to be able to receive an early screening or treat a cancer diagnosis and countless lives will be saved.”
NC Child said the expansion agreement “is incredible news for North Carolina’s families.
“When this measure becomes final, over 100,000 parents and caregivers in our state will finally be able to get the health coverage they need to stay healthy and care for their children.
“Medicaid expansion will mean better health for North Carolina’s kids and their parents. When parents and caregivers have health coverage, children are more likely to be covered as well.
“Research has found that states that expanded Medicaid have significantly lower rates of uninsured children.”
The left-leaning N.C. Justice Center called the agreement “a huge win for North Carolina.”
“While we celebrate that the two chambers have finally reached this historic agreement, we are disappointed that the fate of Medicaid expansion will be tied to the passage of a state budget.
“Over half a million North Carolinians need to access lifesaving healthcare now, and we urge the General Assembly to make Medicaid expansion effective immediately upon passage of House Bill 76.”
