NC House Republicans push Medicaid, echoing Democratic arguments they once fought
Echoing arguments that Democrats have made for years, Republicans in the N.C. House of Representatives voted Tuesday to move forward with Medicaid expansion under the Affordable Care Act.
But differences between the House and the N.C. Senate could still prevent expansion from becoming law. Although both support the idea in general, they differ on details like how and when it should go into place.
In the House on Tuesday, a Medicaid expansion bill passed 102 to 6. It wouldn’t expand Medicaid immediately, however. Instead it would authorize a study, to be followed by a second vote in December — after the midterm elections — on expansion itself.
The December vote likely wouldn’t be as one-sided as Tuesday’s vote, N.C. House Speaker Tim Moore said, explaining that some of his fellow Republicans who voted for the study Tuesday are likely to oppose expansion when it comes down to it. But he’s personally for it, Moore said, and believes that enough others in his caucus will agree for the December vote to succeed, too.
“I see federal funds that are available, that our citizens are paying and are not coming back, are going to other states,” said Moore, a Cleveland County Republican.
That is the same argument Democratic Gov. Roy Cooper made for Medicaid expansion when he became governor five years ago.
“Right now, North Carolina tax dollars are going to Washington, where they are being redistributed to states that have expanded Medicaid,” Cooper said in a January 2017 speech, just a few days after being sworn in.
It marks an abrupt about-face at the legislature, where GOP leaders spent years fighting against Medicaid expansion, while Cooper and legislative Democrats made it one of their top priorities. But following national Republicans’ failure to repeal Obamacare, plus a growing push by rural community leaders who would benefit from Medicaid expansion — from hospitals to county governments and more — local Republicans have now come around to the idea.
Wait until December for Medicaid expansion?
Several Democrats expressed concern about the House’s strategy of pushing back the real vote on Medicaid expansion until December. Chatham County Rep. Robert Reives, the top Democrat in the House, asked Moore to promise that the December vote would actually happen. Moore did.
“I hope that, living in a first world country, we recognize that healthy people are better for all of us,” Reives said.
Forsyth County Rep. Amber Baker told Moore she was worried this might delay expansion, only for Republicans to shoot it down. Moore told her that “I would not be wasting my time, or your time” if he thought the bill would fail to pass.
And in an argument aimed at conservative skeptics, Moore said he believes Medicaid expansion will probably happen here sooner or later no matter what the legislature does now. He urged them to see this as an opportunity for Republicans to craft the rules they want.
“Instead of the feds or anyone else just creating something and sending it here, this is something we have the opportunity, from start to finish, to make sure it makes sense for North Carolinians,” he said.
Republican leaders in the Senate have pushed a different strategy, advancing a Medicaid expansion bill that would authorize it immediately, giving health care coverage to over half a million North Carolinians who can’t afford private health insurance but are also not poor enough to qualify for Medicaid under the current rules.
“If there’s a person in the state of North Carolina who has spoken out against Medicaid expansion more than I have, I’d like to meet that person,” Senate leader Phil Berger told reporters when he publicly came out in favor of Medicaid expansion last month. “In fact, I’d like to talk to that person about why my view on this has changed.”
A hypothetical example of a person who will likely not have health insurance unless Medicaid is expanded, which Berger and others have cited several times, is that of a single mom with two kids who makes roughly $15 an hour working at a job that doesn’t offer benefits.
Hospitals and doctors picking sides?
In addition to wanting to move faster than Republicans in the House, Senate Republicans also added several unrelated changes to health care policy that would make major changes to the multi-billion-dollar health care industry.
Those changes include the SAVE Act to lift a set of regulations on nurses; a partial repeal of “certificate of need” laws that limit expansions by medical facilities; and expanded telehealth rules. Some of those pieces are supported by free-market advocates or lobbying groups representing businesses and nurses. However, some are opposed by other lobbying groups representing doctors or hospitals.
The House version of the Medicaid expansion bill, on the other hand, has none of those extra changes. It has Medicaid only. And on Tuesday, in a committee hearing just before the final vote, top representatives for the state’s medical groups came to make it clear they enthusiastically support the House version of the bill, a stark contrast to the frosty reception they gave the Senate’s version.
Moore had representatives from those groups stand at the committee and be recognized.
“We are very pleased” with the House version of the bill, said Chip Baggett, CEO of the N.C. Medical Society, which represents doctors.
Steve Lawler, CEO of the N.C. Healthcare Association, which represents hospitals, also spoke in favor of the bill Tuesday.
“If you represent a rural community, chances are your hospital is in trouble right now,” Lawler said. “This is a way to make sure we are stabilizing our rural hospitals.”
For more North Carolina government and politics news, listen to the Under the Dome politics podcast from The News & Observer and the NC Insider. You can find it at https://campsite.bio/underthedome or wherever you get your podcasts.
This story was originally published June 28, 2022 at 4:55 PM.
