NC House gives bipartisan approval to Medicaid expansion

The state House gave preliminary approval to a proposal expanding Medicaid, would offer about 600,000 low-income adults in North Carolina the chance to sign up for health insurance.

The 96-23 vote marks the first time the full state House has acted a bill expanding Medicaid. The bill will move to the Senate after another House vote that is largely a formality.  Challenges remain and hard negotiations between the House and Senate are likely ahead.

Wednesday’s debate on House bill 76 was brief. The state has been talking about Medicaid expansion for years.

Last year, the NC Rural Center President Patrick Woodie told a legislative committee that rural residents are disproportionately uninsured compared to the state’s urban and suburban residents.

That same group of legislators heard former Ohio Gov. John Kasich implore them to pass Medicaid expansion. “Great states can do great things,” he told them.

North Carolina has a higher percentage of uninsured residents compared to the national average, according to the U.S. Census.

North Carolina is one of 11 states that has not moved to expand Medicaid.

The federal government would pay 90% of the cost for people who gain health insurance through expansion. Under the House bill, hospitals would pay the other 10%.

The federal government is offering financial incentives to states that have not yet expanded Medicaid that in North Carolina would amount to about $1.5 billion.

Those who would gain insurance fall into what’s called the health insurance gap. They make too little to qualify for subsidized health insurance offered through the Affordable Care Act marketplace but make too much to qualify for regular Medicaid.

Rep. Donny Lambeth, a Winston-Salem Republican who has been working on expansion for years, said most people who would qualify for Medicaid under expansion work. They sacrifice health insurance so they can afford food and clothes, he said.

“Expansion makes financial sense for our state, especially our rural areas,” he said. “I’m concerned about rural North Carolina. Health care in rural parts of North Carolina is often challenged.”

The House bill does not include changes to the state certificate of need law, which requires health providers to get permission from the state Department of Health and Human Services to build new facilities and purchase major equipment.

The expansion bill the state Senate passed last year included limits to certificate of need and other health policy changes. Senate Republicans have been trying for years for significant certificate of need rollbacks, and Senate leader Phil Berger said last year that Medicaid expansion needed to be in the package with policy changes.

Hospitals have fought changes to the certificate of need law. Negotiations last year over certificate of need as part of an expansion bill flopped.

For most of the years the state has been talking about expansion, Democrats pushed for it and Republican leaders were staunchly opposed. Chances for passage shifted last year when Berger announced he had changed his mind.

Three amendments to the House bill passed easily. Under the first, the state would negotiate to add Medicaid work requirements if the federal government signals it will allow them. Second, the counties would get $50 million for Medicaid eligibility determinations and inmate medical costs. The third amendment provides for a loan forgiveness program for doctors and nurses who agree to work full-time in rural counties.