Medicaid expansion is back on the table in NC House. Here’s what happens next
Medicaid expansion is back on the table at the North Carolina legislature.
The Republican-majority House will consider a bill Thursday about Medicaid expansion that could mean the state won’t miss the deadline for the $1.5 billion signing bonus from the federal government to expand it this year.
Wednesday evening, House Speaker Tim Moore called the bill a “fiscally conservative approach” to Medicaid expansion. He announced late Thursday that SB 408, the “Rural Healthcare Access and Savings Plan,” would be discussed in the House Health Committee.
SB 408 would create a Legislative Medicaid Rate Modernization and Savings Oversight Committee and increase access to healthcare in rural areas, according to the bill draft. Moore said Republicans have been working on the bill for several weeks with N.C. Department of Health and Human Services Secretary Kody Kinsley.
Republicans in North Carolina have opposed Medicaid expansion for years, even as most states in the country, under either party’s control, have voted to expand it. There are roughly half a million uninsured North Carolinians who would get health care coverage if it passes into law, and the costs would be paid for almost entirely by the federal government.
Many of those who would benefit work retail, service or part-time jobs that don’t offer benefits. They make too much money to qualify for Medicaid under the current rules, but too little money to afford private health insurance.
Whether or not North Carolina expands Medicaid has been a policy debate for years, and often tied to the state budget process between the Republican-majority General Assembly and Democratic Gov. Roy Cooper.
The bill is more of a plan than direct expansion, and some hoops have to be jumped through before a vote on expansion would be taken in mid-December.
Moore said he spoke with Cooper on Wednesday about the bill. Cooper’s office has not responded to The News & Observer’s request for comment on the proposal.
“You’ve got a bill that really represents the highest and best position of the House on this issue,” Moore said.
But Senate leader Phil Berger still wants Medicaid expansion to part of this session’s budget negotiations. Earlier this week, Moore told reporters that he didn’t want Medicaid expansion to be part of budget talks. Berger said he did, and that he talked to Moore about it on Wednesday.
“So, the House has gone from ‘No,’ to ‘Let’s study it again,’” Berger said in a statement to reporters on Wednesday night. “Remember, we authorized a study in last year’s budget. It is past time for action. The House should pass the Senate version of House Bill 149, or we should agree to incorporate it into the budget.”
Moore countered by saying legislators can pass a budget without including Medicaid expansion.
Or, Moore said, they could also not pass a new budget bill as the budget signed into law by the governor in November was a two-year spending plan.
The two GOP plans are very different
A bill containing Medicaid expansion, plus a number of other changes to the health care industry, passed the Republican-controlled Senate recently but faced opposition in the Republican-controlled House.
And while both the Senate bill and the House bill Moore announced on Wednesday do address Medicaid, they differ significantly in the details.
For one, the Senate bill would implement Medicaid expansion immediately whereas the House bill would require further studies first. The Senate version has several massive changes to the health care industry — unrelated to Medicaid — pushed by regulatory reform advocates but opposed, at least in part, by some hospitals and doctors.
The House bill does not contain those same provisions, which include broader access to telehealth options, permission for certain nurses with advanced training to take on more medical duties, and a partial repeal of North Carolina’s “certificate of need” law that restricts competition in the health care field.
If it moves ahead in committee, the bill could be voted on before the session ends. However Moore said that he won’t call for a floor vote unless there is more support for it beyond just the House Republican caucus.
“I want to see a pathway forward with it. If I don’t see a pathway forward on it, we’re not going to vote on it. I don’t see a reason politically just to pass this,” he said.
And that caucus support comes down to the federal money coming to North Carolina if they vote to expand.
“If there wasn’t the $1.5 billion, I’d say there would be less support for it,” Moore said.
House Democratic Minority Leader Robert Reives told The N&O on Wednesday night that the Democratic caucus is still discussing the bill.
“I am ecstatic that the House is actually considering doing something with Medicaid. And I think the important part is that no matter what happens with this bill, that means that now we have a full conversation going, and that is incredibly important,” Reives said.
This story was originally published June 22, 2022 at 6:45 PM.
