Millions in federal money has gone unspent for weeks because legislators have put off talking to the state Department of Insurance about how a national health insurance grant will be used.
Lawmakers dropped discussion of the $12.4 million grant from the Oct. 27 agenda of a high-powered group called the Joint Legislative Committee on Governmental Operations. Agencies must consult with the committee, which House Speaker Thom Tillis and Senate leader Phil Berger run, before spending grant money in certain circumstances.
The money is for the state to do prep work for a health benefit exchange that the federal health insurance law would require of all states by 2014. With no grant money to support it, most of the work at the state Department of Insurance and the N.C. Institute of Medicine on the exchange has stopped.
The health exchanges are a central piece of the new federal health overhaul, which calls for states to set up marketplaces where small businesses and people without health insurance through their jobs will shop for coverage.
Legislative Republicans have taken something of a sideways stance in dealing with a health care law they oppose. GOP leaders signed a friend-of-the-court brief backing a lawsuit challenging the constitutionality of the requirement that individuals have health insurance. A bill that would have set up the health benefit exchange failed to move in the Senate.
However, legislators in their budget indicated they intend to set up a state-based exchange, and they told the state Department of Insurance and the state Department of Health and Human Services to use grants to get ready.
'We want to be careful'
The Insurance Department applied for a federal grant and was told in August it would get the money.
Berger said this week that legislators removed the grant discussion from the October meeting's agenda because they wanted more information about how the money would be used, and whether accepting it ties the state to future obligations. The discussion is back on the Nov. 29 committee agenda, he said.
Some lawmakers object to setting up a state-run benefit exchange, Berger said.
"This is just one little slice in what is a huge potential change in health care and health care law," he said. "We want to be careful."
If a state decides not to run its own exchange, the federal government will set up an exchange in the state, which the state would have the option of helping run.
State Insurance Commissioner Wayne Goodwin, in a letter Nov. 4 to Berger and Tillis, wrote that the delays are hurting the state's efforts to set up its own exchange.
If the grant is not on the agenda Nov. 29, Goodwin said, the department would have to wait until Dec. 13 to start using the money. Goodwin said the state law requiring consultation with the legislative committee considers the requirement met after 90 days.
"I am very concerned that these and other delays may set the state up for failure," he wrote.
"If the federal government does not certify our state as having progressed sufficiently in our development of a state-based exchange, our citizens will have no choice but to be subject to the plans, operations, and regulatory authority of the federal government."
