Raleigh, N.C. — The state Senate gave tentative approval Monday to revamping North Carolina's Medicaid program, voting 38-10 to create a system that would use both out-of-state managed care companies as well as home-grown "provider-led entities" to care for the state's poor and disabled.
A final vote on House Bill 372 is expected Tuesday.
The measure is the latest version of the bill that has been the subject of a years-long debate between the House and the Senate. Senators rolled out this version of the bill in committee last week.
"The unique part of this compared to what we have currently have is competition," Sen. Ralph Hise, R-Mitchell, said.
Under the plan, the state would contract with up to three managed care companies to provide insurance across the state. At the same time, groups of doctors, hospitals and other health care providers would be invited to form entities that would act as both insurers and health care providers. Rather than pay these groups a fee for each individual service provided, as is the case now, both the statewide and local insurers would get a set amount per patient.
Such a "capitated" system moves the risk for big cost swings to insurers and away from the state.
Sen. Angela Bryant, D-Nash, asked what guarantee patients have that insurers would allow them access to doctors they prefer or the services they need.
Hise said competition between the two levels of providers will ensure that insurers would work hard to meet patient needs.
"If a particular plan is not meeting their needs, they have multiple plans to move through," he said.
The legislation creates a new Medicaid department whose secretary would be confirmed by the General Assembly.
Although the bill enjoyed bipartisan support, some Democrats used the vote to raise questions about Medicaid expansion. The Affordable Care Act, sometimes called "Obamacare," allows states to cover a broader slice of the population than North Carolina currently does. Initially, the cost of expansion would be heavily subsidized by the federal government, but legislative Republicans have resisted expansion, saying they fear an explosion in costs.
"If this plan goes into effect, we still have 500,000 people without care," Sen. Gladys Robinson, D-Guilford, told Hise.
Robinson asked if Republicans would change their position on expansion if their reform plan went into effect. Hise said that would depend on the federal government.
"What they've offered under the Affordable Care Act is a bad deal for North Carolina," he said, insisting that the state could get stuck with a big bill for expanding coverage to "able-bodied adults."
That provoked an objection from Sen. Joel Ford, D-Mecklenburg, who said the people Hise was talking about couldn't afford to buy health coverage on their own.
"I would ask you for a little bit more compassion for those people who get up and go to work," Ford said.