NC House Republicans back their own Medicaid expansion plan, but final deal still elusive

House Republicans on Wednesday backed a pathway to Medicaid expansion in North Carolina, promising a vote in December that could provide taxpayer-funded health insurance to hundreds of thousands of people, if the federal government signs off on key requirements.

Now the two sides will negotiate over an issue they’ve both been dug-in on. The initial response from Senate leadership Wednesday was not positive, with Senate President Pro Tempore Phil Berger noting that the House proposal creates yet another legislative committee to talk about the long-running issue.

“So, the House has gone from ‘No’ to ‘Let’s study it again,’" Berger, R-Rockingham, said in a statement. "Remember, we authorized a study in last year’s budget. It is past time for action. The House should pass the Senate version ... or we should agree to incorporate it into the budget.”

Regardless, the new bill will be part of ongoing negotiations as lawmakers work to pass a state budget and wrap up this legislative session, potentially by the end of this month. Berger and Speaker of the House Tim Moore planned to meet Thursday afternoon on the state budget, though Moore insisted Thursday that Medicaid expansion will be a separate discussion.

Berger has said he'd like to see expansion language included in the budget.

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Moore said the House plan has enough support to pass his chamber, where the GOP majority has repeatedly rejected the Senate proposal. Moore, R-Cleveland, called the House’s plan “the highest and best position of the House” and said that the regulatory rollbacks in the Senate plan won’t be part of any final package.

Berger and other leaders have said those reforms are important measures to increase the overall supply of health care in the state by reducing red tape for hospitals and empowering advanced practice nurses to handle more patient issues.

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The new bill calls on the Cooper administration to push for work requirements for newly covered people, or something like work requirements, as it negotiates with the U.S. Centers for Medicare & Medicaid Services. The Cooper administration would also have to show that the plan would save the state money overall.

House Republicans said they believed federal regulators would agree to all the benchmarks in the bill, paving the way for the committee to sign off on the deal Dec. 15. Then, the bill says, the full House would vote “on or after” Dec. 16 to implement the committee’s recommendation and expand Medicaid in the state.

That plan would then go to the state Senate.

The bill also contains a number of triggers, similar to the Senate plan, for after expansion is approved. If the federal share paying for expansion—which would cost billions of dollars—falls below 90%, expansion would end in North Carolina, dropping the newly added people from the state's health insurance rolls.

The bill also divvies up much of the $1.5 billion Congress put into one of the recent COVID-19 relief bills to entice states that have not yet expanded Medicaid to do so. This legislation promises $1 billion of that to combat opioid addiction and provide mental health services.

Moore acknowledged Wednesday that the state remains a long way from actually approving Medicaid expansion.

“I don’t know if the Senate will agree to it,” he said.

Moore presented the new bill Thursday to the House Health Committee, and he made many of the same expansion arguments Democrats have made for a decade.

North Carolina taxpayers already send tax dollars to Washington to pay for expansion, and it's time to bring that money home, he said. North Carolinians already absorb health costs for uninsured people in the state, who often seek care in hospital emergency rooms, in the form of higher insurance premiums and other hidden costs, he said.

Moore and Berger have both said the government should help hard working people in the state who can't afford health insurance. Asked Thursday why those arguments are winning over the legislature's Republican majority now, but didn't before, Moore responded much as Berger has in recent weeks, saying he now trusts the federal government to hold up its end of the bargain on expansion.

After years of Republicans trying to kill the program, along with 2010 Affordable Care Act it was part of, expansion and the federal promise to fund 90% of its costs are clearly here to stay, Moore said.

“It stayed in place with a Republican [U.S.] House, a Republican Senate and a Republican president," Moore said. "If it didn’t change under that, when’s it going to change? So the feds have made their decision on that.”

Moore also acknowledged that waiting for a final vote in December puts the November elections, in which all 170 General Assembly seats are up, behind lawmakers who may be nervous about the political ramifications of voting for expansion. The state also needs to give the Cooper administration time to negotiate details with the federal government.

“Any time you can take the politics out of it it helps," Moore said. "But really we need that time to get a plan back from [the federal government]."

Moore said one of the strengths of the House Republican plan is that final approval won't come until those details are set, as opposed to approving expansion and waiting to see exactly what the federal government will allow in a plan tailored to North Carolina.

“I can’t stress enough the importance of us fully understanding and grasping what it is we’re doing before we do it," he said.