Democrats call for straight-up Medicaid expansion
House and Senate Democrats called Wednesday for a quick move toward Medicaid expansion in North Carolina, making their opening play on one of the biggest-ticket items to be debated during the new legislation session.
Posted — UpdatedDemocrats said they can expand the program to as many as 500,000 people without a hit to the state budget. The federal government would cover 90 percent of new costs, and the other 10 percent would come from hospitals around the state, which have agreed to a new assessment commonly called a "bed tax" to raise the money.
Carolina Cares also includes a bed tax.
Senate Bill 3 would expand Medicaid to anyone ages 19 to 64 whose income puts them at or below 133 percent of the federal poverty level. That's about $16,612 for one person and about $34,250 for a family of four.
Expansion is the most impactful thing the legislature can do this year, both for health care and the state's economy, Democrats said. The state would see an infusion of billions in the coming years in federal funding for the program.
Democrats also hit repeatedly on the state's opioid crisis Wednesday, saying expansion money would help tackle that problem and mental health in general.
The Senate is the heavier lift, and Senate President Pro Tem Phil Berger has said repeatedly that he hasn't seen an expansion plan that doesn't create financial problems for the state down the road. He reiterated that Wednesday as the legislature gathered in Raleigh for the 2019 session.
"My position hasn't changed," said Berger, R-Rockingham.
Thirty-seven other states have adopted expansion, though, including a number of Republican states.
During a press conference featuring dozens of Democrats from both chambers, several legislators acknowledged a need for compromise on the issue. Sen. Ben Clark, D-Hoke, mentioned work requirements and co-pays as likely areas of discussion.
As of now, the Democratic bill limits co-pays by requiring them to be in line with the minimal costs non-expansion Medicaid recipients pay. The Carolina Cares plan would require participants to kick in 2 percent of their annual income as an insurance premium and pay routine co-pays.
Some see work requirements as an easy point for Democrats to concede since most of the expansion population likely already works. Expansion is meant to fill a coverage gap – adults who make too much money to qualify for traditional Medicaid but not enough to get federal health insurance subsidies provided by the Affordable Care Act.
Legislative Democrats said they'd rather see a simple expansion, which could be in place by Nov. 1 if passed. Work requirements and other changes would require waivers from the federal government that could take months – or longer – to receive.
With the session just starting, it's difficult to predict how the debate will go, but Cooper is likely to include expansion in the state budget proposal he rolls out in about a month. His veto has new teeth with the Republican super-majorities broken, setting up a potential budget standoff over expansion.
State government wouldn't shut down if budget talks go past the July 1 start of fiscal 2019-20, though. State law essentially continues the old budget as is until a new deal is struck.
The industry is fighting that plan, saying it could cripple hospitals.
Democrats acknowledged Wednesday that debate and others in the health care sector might get wrapped into the expansion debate, but they also said they hope to keep things separate.
"There's no telling where the conversation might go," Senate Minority Leader Dan Blue said.
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