Rep. Donny Lambeth knows he has a tough job ahead convincing some of his fellow Republicans that it’s a good idea to offer health care coverage to more working poor people by letting them buy government insurance.
The former hospital administrator from Winston-Salem is ready with these points: It won’t cost the state anything - it will actually help save $45 million a year - and it will help rural hospitals now shedding jobs because income from Medicare has dropped.
“Rural hospitals will close,” Lambeth said. “They can’t survive those cuts.”
At a news conference detailing the plan, Lambeth and other speakers steered clear of calling it “Medicaid expansion,” a term that’s toxic to some politicians. “I don’t view it as expansion, not the way most of the states that expanded Medicaid approached it,” Lambeth said.
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Medicaid is the government health insurance program for poor, elderly and disabled people. Most of the 1.9 million people enrolled in North Carolina are children. It is difficult for adults younger than 65 to qualify. The state and federal government cover Medicaid costs, with the federal government paying most of the bill.
The state would save money because Medicaid payments to hospitals for treating people who don’t have insurance would drop, he said.
Thirty-one states and the District of Columbia have expanded Medicaid, but some Republican-run states have resisted.
Under House bill 662, state hospitals rather than state government would pay costs not covered by the federal government or user premiums. The N.C. Hospital Association said it is analyzing the bill.
Adults whose incomes are at or below 133 percent of the federal poverty level – less than $16,000 for a single person – would qualify. They would have to pay annual premiums equal to 2 percent of their household income for Medicaid coverage, with some hardship exemptions. In most cases, adults would have to be working or “engaged in activities that promote employment” to be eligible for the coverage.
Beneficiaries would also have to have routine physicals and other preventive care.
The federal government would have to approve a program that has work requirements and premium payments.
An estimated 300,000 to 500,000 people in North Carolina would have gained health insurance under a routine Medicaid expansion. It is unknown how many people would choose coverage with premiums and other requirements.
The bill has its critics.
Becki Gray, a senior vice president at the conservative John Locke Foundation, said it doesn’t make sense for the state to make such a big change because no one knows how Congress will handle health care.
“We don’t know what the health care system will look like,” she said. “It’s premature and ill-conceived to move forward with this right now.”
Health care advocates said poor people would forgo coverage because they couldn’t pay the premiums.
“Low income people who are eligible and who need access to medical care would be negatively impacted by a Medicaid program that required the payment of premiums,” Carolyn McAllaster, a clinical professor of law at Duke University, said in an email.
Speakers at the proposal’s official roll-out emphasized the financial straits of rural hospitals and the health-care needs of rural residents.
Alex Hitt, owner of a family farm in Alamance County, said he purchases health insurance for three people, including himself, through the marketplace set up under the Affordable Care Act, and worries about what will happen if it dies.
Small farms, like other small businesses, risk bankruptcy when someone gets sick or hurt and they can’t pay the medical bills, he said.
“This is particularly a jobs bill that will help folks run their businesses and hire folks,” Hitt said.