The state House on Tuesday set the stage for negotiations with the Senate over how to control Medicaid costs in North Carolina.
On a vote of 105-6, the chamber approved its version of Medicaid reform, written into House Bill 372. The Senate has written its version into its proposed budget, along with other policy issues.
Many of those issues, including Medicaid, will now be negotiated between the two chambers as they put together a final budget. The process is expected to take weeks, but Senate leaders have said they will come up with a Medicaid plan this year no matter how long it takes.
Tuesday’s overwhelming House vote was the result of a carefully constructed bill that took into consideration a wide range of interests – doctors, hospitals, insurance companies – along with the concerns of individual legislators.
Several Democrats also spoke in support of the bill. It make the House version sturdier when negotiations begin because of the strong bipartisan vote behind it.
Rep. Marilyn Avila, a Republican from Raleigh, said she voted for the bill in spite of her reservations that it is too narrowly focused without other options, because it will be improved through a conference committee of House and Senate members.
"We should approach with caution," she said.
Rep. Nelson Dollar, a Republican from Cary, said the House version would provide greater certainty for budgeting, long-term cost savings and improved health outcomes.
Senate Republican leaders want to move Medicaid from the state Department of Health and Human Services and create a board of appointees to oversee it. There would be a chief executive officer, and the board would contract with private insurers and health care firms. People who receive Medicaid would be able to choose from three to five medical providers.
The House plan leaves the program in DHHS, and would have doctors running the contracted health-care companies. Both plans would finance care on a per-person basis, rather than paying for each medical appointment or procedure as it does now.
Health and Human Services Secretary Aldona Wos issued a statement in support of the House plan.
"We commend the House for the overwhelming, bi-partisan passage of a Medicaid reform bill that is based on what works in North Carolina and aligns with the principles of Governor Pat McCrory's Healthy NC initiative,” Wos said. “This is the year for North Carolina to move forward with historic reform.
“We look forward to working with both chambers to pass reform that creates a more predictable budget for taxpayers, reduces waste, and rewards health care providers for delivering quality, cost-effective care to patients."
Medicaid is a federal- and state-funded health program that benefits the poor, the elderly and the disabled. It accounts for more than 17 percent of the state’s general fund.