GOP Medicaid plan again advancing in House

The House bill would allow working people who make less than 133 percent of the federal poverty guideline to buy into Medicaid. For example, a family of four making less than $34,000 a year would be eligible.

But they would have to pay for the coverage, even if they make just a few thousand dollars a year. In addition to co-pays for services, enrollees would have to pay the state a premium of 2 percent of their income.

Sponsor Rep. Donny Lambeth, R-Forsyth, said people are willing to do that.

"One thing they told me as I was talking to these individuals is, they’re proud, and they want to pay something.," Lambeth said. "They just can’t pay the premiums that the employers charge because of the high cost. But they said to me, 'I’m willing, and I want to pay something.'"

However, Rep. Verla Insko, D-Orange, said other states have found that premiums don't raise much money and cost a lot to administer.

"This actually creates a lot of problems," Insko said. "In Iowa, about 6,000 people were sent to collections for failure to pay. We don’t need to get into that kind of thing with poor people. Another 500 were dis-enrolled. So, the premium creates all kinds of problems."

Among the changes adopted Wednesday, the program would end if courts decide that states aren't allowed to impose a work requirement or if federal funding for the program falls below 90 percent of the cost.

Democrats said the work requirement would be a bureaucratic nightmare to track and doesn’t include enough exceptions for counties with high unemployment or that were hit by a natural disaster.

Republicans said the work requirement isn't negotiable.

Health care advocates called the bill a good starting point.

"Right now, there are over 400,000 hard-working North Carolinians who lack any affordable option for health insurance. We believe that H655 is a well designed plan that will go a long way toward closing that gap," said Erica Palmer Smith, director of Care4Carolina, a coalition of 45 groups backing Medicaid expansion.

Republican supporters also noted the proposal could help rural hospitals keep their doors open. Many are struggling to stay afloat because so many of their patients are uninsured.

House leaders have pledged to give the bill a floor vote sometime in early October. But even if it passes the House, its political future doesn’t look bright, as Senate leaders remain firmly opposed to any kind of Medicaid expansion.