Is this the year NC gets Medicaid expansion?

Linda Rider

By Anne Blythe

The state Legislative Building designed by architect Edward Durell Stone almost 60 years ago has a maze of hallways where lawmakers often buttonhole each other for private discussions about contentious public issues.

Rep. Donny Lambeth (R-Winston-Salem) is one of those lawmakers who has been taken aside recently to discuss the pros and cons of expanding Medicaid in North Carolina.

“One of the hallway conversations always comes around to, ‘Well so and so state has had all kinds of financial problems because they expanded Medicaid’  … so I really want to understand what has been the experience in other states as far as balancing their budgets, the impact on their operating funds and pressure it puts on their operating funds because they expanded,” Lambeth said Friday at the first meeting of the Joint Legislative Committee on Access to Healthcare and Medicaid Expansion.

While lawmakers from both parties have talked about ways to expand health care access for a while, there seems to be more momentum behind the joint House and Senate committee whose charge grew from budget negotiations last year with Democratic Gov. Roy Cooper, an expansion advocate. 

Rep. Donny Lambeth (R-Winston-Salem) discussed some of the structural issues with Medicaid that the legislature has addressed over the past few years during a press conference at the NC General Assembly in 2019. Photo credit: Emily Davis

The new panel of lawmakers met for the first time on Friday to probe how to provide health care coverage to some 500,000 low-income adults who could have access to Medicaid if North Carolina joined 38 other states and expanded the program as the Affordable Care Act has allowed since 2013.

Through much of the past decade, Medicaid expansion has been a thorny topic that has divided Democrats, who support it, and Republicans who have resisted adding more North Carolinians to the subsidized government health insurance program. More recently, some Republicans including Senate Leader Phil Berger (R-Eden) have warmed up to the idea, recognizing a need to close the insurance gap in the state. 

Dispelling misinformation

The federal government subsidizes 90 percent of the cost for adults enrolled through the ACA expansion. The American Rescue Plan Act of 2021 provides additional financial incentive for the 12 states that have yet to approve expansion, allowing them to temporarily draw down additional federal funds. 

The National Conference of State Legislatures estimates North Carolina could get an additional $1.5 billion to $2 billion in additional federal funding. Kate Blackman, NCSL health director, and Emily Blanford, NCSL program principal, presented a report to the legislators on Friday with specifics on North Carolina and an overview of what other states have done.

Lambeth told Blanford about another hallway conversation he’s had, one that many Republicans have echoed as they explained their financial worries about expanding Medicaid. They worry the federal government will shift the fiscal burden to the state by decreasing its percentage of funding either abruptly or over time.

“The second part of that financial piece — you know, hallway conversations — is ‘Well, you know they started at 100 percent, that rate dropped to 90. What prevents them from going down to 70 or 60 or 50, and pull the rug out from under us and put more pressure on our state budget because all of a sudden now we’ve done it. It’s hard to take away a benefit, and we’re just going to have to pay more because you know, they kind of pulled that rug out from under us on that 90 percent,’ ” Lambeth said. “What does the law say about the 90 percent and how would that percent be changed?”

The federal government’s commitment to providing states with 90 percent of the expansion cost is written into the Social Security Act, Blanford responded, so it would take an act of Congress to change the law.

Lambeth explained after the meeting that he was trying to get answers throughout the two-and-a-half-hour discussion to dispel misinformation he’d heard from legislators who often stopped him in the corridors because they knew he was co-chair of the new committee.

Chilly caucus

Though some longtime critics of expansion have warmed to the idea during the coronavirus pandemic, such as the powerful leader of the Senate, there still are staunch opponents, especially in the state House.

“We’re not lukewarm in the House,” Lambeth told reporters after the meeting. “It is still rather chilly. It is a heavy lift to convince our House caucus that this is the right direction to go. Now is it impossible? No. I wouldn’t be here if I thought it was impossible.”

The committee touched on a wide range of health care topics Friday. The lawmakers discussed how to rein in the surprise medical bills that insured people get after inadvertently receiving care from an out-of-network provider they did not choose. They also discussed the shortage of nurses and other health care providers already hampering the state and how to help struggling rural hospitals and expand care access in those areas.

The next meeting of the Medicaid expansion committee is set for March 1.

The health care session’

The coronavirus pandemic has exposed under-funded health care systems and a lack of convenient access to quality care for numerous North Carolinians, many who live in some of the more rural districts represented by Republicans.

Lambeth said he expected the committee to spend months fact-finding and creating recommendations for what he called a “North Carolina plan” that could be ready in August or September and perhaps put to a full General Assembly vote by October. That could be a politically charged vote before the November elections.

That plan might expand Medicaid or subsidized coverage to hundreds of thousands of North Carolinians without specifically calling it “Medicaid expansion.”

“I can sort of view this as the health care session,” Lambeth said.

Sen. Kevin Corbin (R-Franklin), a committee member, is interested in exploring an array of programs that he has heard other states have used. “The view from 130,000 feet is we have a large number of uninsured people,” he told reporters after the meeting. “We need to get those people insured. How to do that is the question.”

“Medicaid expansion” used to be a bad word in some corridors of the Legislative Building, he said. “I think it has been, but I think it’s not so much anymore,” Corbin said.

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