North Carolina hospitals weigh in on Medicaid expansion, but top lawmaker isn’t satisfied
North Carolina Senate leader Phil Berger is displeased with a counter-proposal to his chamber’s Medicaid expansion bill as he and powerful interest groups slog through a months-long stalemate.
Huddled in private side conversations at an event in Chapel Hill Monday afternoon, some of the state’s top leaders discussed what needs to happen to expand Medicaid in North Carolina — although they declined to fill reporters in on the details.
“I’m not going to negotiate in the press,” Berger told a group of reporters just after he and Democratic Gov. Roy Cooper finished speaking one-on-one, and just before Berger left to speak with UNC Health CEO Dr. Wesley Burks.
But the Republican senator confirmed he’s not happy with a proposal from the North Carolina Healthcare Association, which has an interest in Medicaid expansion talks.
“No,” Berger said when The News & Observer asked whether the NCHA’s suggestions would satisfy his expectations. “It’s not even close.”
A key stumbling block in the negotiations has been a disagreement between Berger’s Senate Republican caucus and the state’s hospitals. The Senate wants to pair Medicaid expansion with other changes to health care laws that hospitals and doctors oppose. So far the N.C. House has expressed a willingness to expand Medicaid, but only if not paired with those other changes.
More than 500,000 uninsured North Carolinians would qualify for state and federally funded health care if the General Assembly approves an expansion plan.
Republicans have moved closer to a Medicaid deal
The expansion provision — an Obama-era option devised under the Affordable Care Act — was long dismissed by North Carolina’s Republican-controlled legislature even as Cooper, a Democrat, campaigned in 2016 and 2020 in part on pushing for expansion. But in the last year GOP lawmakers, including Berger, a Republican from Eden, and House Speaker Tim Moore, a Republican from Kings Mountain, changed their minds.
Berger announced his reversal on Medicaid expansion first, saying in May he’d fight for it to pass — after spending the last decade keeping North Carolina as one of the few states not to accept expanded coverage under the Affordable Care Act. Moore wasn’t at Monday’s event, but Berger told reporters there that while the two of them do still disagree on the best path forward, they talk regularly about the need for their two chambers to agree on a deal.
“Every time I see him, it comes up,” Berger said. “I wouldn’t call it anything close to a negotiation. But he and I talk about it regularly.”
With both Republicans and Democrats championing its merits, Medicaid expansion seemed like a realistic prospect in North Carolina for the first time since its inception. But dispute over an obscure “certificate of need” law has shackled progress.
Certificate of need a sticking point
Since this year’s legislative session, which effectively ended in midsummer, the Senate version of a Medicaid expansion bill has included amendments to North Carolina’s certificate of need law. Certificates of need determine what medical services are available in different parts of the state. A longstanding CON law helps reduce the competition that hospitals could face for outpatient health care services that help pay for other, less lucrative parts of their operations, The N&O previously reported.
The House, in concert with the NCHA, has been adamantly against changing the CON system. But on Friday, the association proposed a possible compromise. In a press release, NCHA Board Chair Dr. Roxie Wells, president of Cape Fear Valley Health Hoke Hospital, said the group was willing to support some changes if it would help finalize Medicaid expansion.
“In an effort to get stalled negotiations moving, and in response to Senator Berger’s and Governor Cooper’s requirement that Medicaid expansion be coupled with certificate of need reform, our board of trustees has made the difficult decision to propose certificate of need law reforms,” Wells said.
The NCHA backed changes for certificates of need on ambulatory surgical centers and an end to the certificates for inpatient space for psychiatric and chemical-dependency patients, The N&O reported.
But Wells cautioned that CON reform could cut into hospital revenue.
“CON law changes could threaten the survival of community hospitals if they are not implemented carefully,” she said. “We are putting a lot of trust in legislative leaders to do this correctly. If this policy damages access to local health care services, we hope that government leaders will find the resources to preserve crucial health care services and facilities, including safety-net services that North Carolinians rely on.”
Others, such as North Carolina State Treasurer Dale Folwell, argue that CONs stymie a competitive market and permit large hospitals to monopolize the health care industry.
“The big hospitals and the hospital association control the quantity of this product through CON,” Folwell said in an interview. “They control the quality of this product. They control your access to this product. They control the price of this product, and they control whether they’re going to break your kneecaps and weaponize your credit score if you don’t pay for this product.”
Cooper told The N&O Monday he was evaluating the NCHA’s proposal and hadn’t come to an opinion on it. His primary interest is finding a way to pass Medicaid expansion, regardless of CON reform.
“I would prefer to let’s just go ahead and pass it just like it is,” Cooper told reporters last week. “But Sen. Berger has said that in order for him to support Medicaid expansion there has to be some other medical reforms. Those reforms have merit. They should be discussed.” He added: “I don’t think it is unreasonable for the hospitals to step up and negotiate with (Berger) on that issue.”
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This story was originally published September 20, 2022 at 12:20 PM.
