Raleigh, N.C. — Senators passed a package of changes to the state's health insurance program for the poor and uninsured on Tuesday, but not before once again rejecting a bid to expand Medicaid coverage to roughly 500,000 North Carolinians who are uninsured.
The Senate voted 34-10 to return House Bill 372 to the House. Under the Senate version of the measure, North Carolina would use a blend of managed care companies and locally created "provider-led entities," or PLEs, to manage Medicaid. The House version of the bill relied exclusively on PLEs, and leaders there say the chamber is almost certain to reject the Senate version. That would trigger a conference committee to work out differences and draft a final bill.
Little of Tuesday's debate focused on the bill itself.
Rather, the bulk of the Senate's time was taken up by an amendment put forward by Sen. Terry Van Duyn, D-Buncombe, that would have expanded eligibility to all those whose earnings put them at less than 133 percent of the federal poverty level. That would capture roughly 500,000 people, many of them relatively young adults who currently fall into coverage gaps.
"By passing Medicaid reform, you're clearing the No. 1 state objection to Medicaid expansion," Van Duyn said.
Republican Gov. Pat McCrory and some GOP lawmakers have said they might consider Medicaid expansion after controlling costs in the existing system. But GOP legislative leaders, particularly in the Senate, have dug in against that idea, saying that the expansion allowed by the Affordable Care Act, what some call "Obamacare," would put the state on shaky fiscal footing.
"I don't know how clearly we can state it. The answer to the federal government and the Affordable Care Act is, 'no,'" Sen. Ralph Hise, R-Mitchell, said.
Sen. Harry Brown, R-Onslow, the chamber's senior budget chairman, said that expansion could end up blowing a hole in the state budget, despite the federal government offering to pick up more than its typical share of costs in the early years of expansion.
"Every state that has expanded Medicaid has created a financial problem in their state budgets," Brown said.
That has not universally been the case. Ohio, for example, both expanded Medicaid and booked a $2 billion budget surplus this year, helped in part by federal expansion funding.
The Senate defeated the Van Duyn amendment 15-29 before passing the overall bill.