The top leader in the North Carolina Senate on Tuesday dismissed a hospital-backed pitch on Medicaid expansion, saying an announcement last week from the hospitals’ lobbying group wasn't a serious effort to break a long-standing logjam on the issue.
Senate President Pro Tempore Phil Berger said the North Carolina Healthcare Association’s offer, sent to reporters shortly after association officials brought it to Senate staff, “looked to me like it was more to deal with public relations than a substantive or serious proposal.”
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He added: “At least they have indicated some willingness to move.”
Berger’s assessment is a setback for expansion talks between the House, Senate, governor, hospitals and other health officials in North Carolina as the state hashes out a plan to expand Medicaid. Republican majorities in both the House and Senate have signaled willingness to expand after blocking the idea, long a top priority for Gov. Roy Cooper and other Democrats, for more than a decade. The Senate passed a plan in early June.
But Berger, R-Rockingham, and other Senate Republicans have insisted that regulatory rollbacks in the health industry be part of the deal, including major changes to the state’s certificate-of-need laws. Those laws limit expansion in the health care industry, protecting hospitals from competition and preserving the balance needed to fund crucial money-losers like emergency rooms with profitable services like elective surgeries, hospital officials say.
In its proposal Friday, the North Carolina Healthcare Association said it would assent to certificate-of-need exemptions for ambulatory surgery centers, effective five years from a go-live date on Medicaid expansion. The group said the changes that it backed would cost hospitals in the state a minimum of $700 million.
But there were several caveats. Berger told reporters Tuesday that they run counter to the point of reform, which is to increase competition. Berger says the state must boost its overall supply of health care, since expansion would provide taxpayer-funded insurance to hundreds of thousands of potential new patients.
Under the NCHA’s proposal, “the only actors in health care that would be in a position to open such a surgical center are the hospitals,” Berger said.
“It looks to me like its more designed to further entrench the monopolies that the hospitals have,” he said. “Ambulatory surgery centers in other states are, in many respects, orthopedic centers or ear nose and throat centers or eye centers. And their proposal would require … three specialties to be in an ambulatory surgery center. That’s not a serious proposal.”
NCHA spokeswoman Cynthia Charles said Berger is incorrect and there already are independently owned ambulatory surgery centers in the state.
"NCHA has made a serious and fair proposal in which any provider could open an ASC in the exempt counties, as long as they have three specialties and can meet the recommended patient safety and quality standards," Charles said in a statement. "The General Assembly had said they were interested in getting input from the state's hospitals and health systems and we have provided it. The next steps are now up to them."
Ultimately these negotiations are between the GOP majorities in the Senate and the House, which has generally backed the hospital position on certificate of need reform. WRAL News also reached out to Speaker of the House Tim Moore for comment, but he didn't immediately respond.
Cooper, speaking to reporters after an unrelated event Tuesday morning, said he had encouraged Berger to counter the hospital authority offer. The two met Monday at an event renaming UNC’s cancer center after late state Sen. Marc Basnight.
Berger told reporters Tuesday that he would not negotiate through the media, but he said the Senate has sent the House “several alternatives" to its initial bill. That bill doesn't just include certificate-of-need reforms. It also includes a rollback on nursing regulations that would give advanced practice registered nurses more autonomy to treat patients without a doctor's supervision.
Nursing advocates say such supervision often amounts to paperwork a doctor signs. Doctors groups oppose the changes. Berger said Tuesday that he hasn't seen any movement from doctors on the issue.
"There continue to be conversations about it," he said. "I do continue to believe that it's part of the overall solution."
Cooper has called on GOP lawmakers to expand Medicaid as soon as possible, noting that the state loses hundreds of millions of dollars in federal funding — and people go without covered health care — with every month that passes.
Berger agreed that “sooner would be better.”
“But that sooner needs to be the result of the right bill and not just any bill,” he said.