NC lawmakers hear strong arguments for Medicaid expansion

The joint committee studying the issue of Medicaid expansion met for the second time—with a full slate of presentations about how expansion would work, how it could be paid for, and whom it would help. They also heard how the state compares nationally.

National Association of State Health Plans director Hemi Tewarson studies policy and data across all 50 states. She said the annual American Health Ranking study shows North Carolina ranks 39th in access to care, 39th in infant mortality, and 38th in affordability.

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That's in large part, she said, because North Carolina has the sixth-highest uninsured rate in the country at 11.3%, with more than 1.15 million people uninsured.

DHHS Medicaid Secretary Dave Richard urged lawmakers to turn those numbers around by expanding Medicaid. It would save the state hundreds of millions of dollars every year, he said, adding that the state's successful transition to Medicaid Managed care last year leaves it "in a very good place" to proceed.

At present, expansion would also bring the state a windfall of $1.7 billion over two years. The American Rescue Plan Act included bonus funds to convince holdout states like North Carolina to sign up.

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"There is no additional state general fund appropriation needed to take advantage of that," Richard told lawmakers. "Expansion at this time, because of what you've done in the past with the managed care plan, because of the incredible support we have from our medical community, because of the financial incentives at this time—it just makes great sense to improve the health of North Carolina citizens."

Patrick Woodie, president of the NC Rural Center, told lawmakers his organization supports expansion because it would be a huge benefit to rural areas, where most people work at small businesses that cannot afford to offer health care coverage.

Woodie said about 665,000, or 65%, of uninsured adults that could be covered by expansion are employed. "This includes agriculture workers, construction workers, childcare workers, cashiers, restaurant workers, delivery drivers," he said. "In other words, essential frontline members of our state's workforce."

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Woodie also noted that expansion would bring health care jobs to rural areas, increase revenue for counties, and help keep the doors open at struggling rural hospitals. "Care for uninsured patients is a substantial financial burden on our rural hospitals. And it is ultimately unsustainable," he said.

Some Republicans on the panel were skeptical. Rep. Donna White, R-Johnston, said there’s already a worker shortage in the state’s health care system.

"I'm getting feedback from people that cannot get into a Medicaid provider physician as a new client," White said. "I'm getting questions from people that cannot get an appointment with their existing family physician.

"It may be the greatest economic thing that we've done, and obviously with all that we've learned, it does seem like a great idea," White continued. "I'm just saying, 500,000 more people in a system that is already at the point that it is right now—we do have to consider that."

Peter Daniel, executive director of the North Carolina Association of Health Plans, pointed out that the state just smoothly transitioned 1.7 million Medicaid enrollees into managed care last year. While he said the plans can't fix the shortage of providers, they've been able to accommodate it so far.

"The capacity of the plans is more than adequate, in my opinion," Daniel told White. "They've built a robust provider network and they are ready to increase that."

"We stand proud and ready for Medicaid expansion if the General Assembly so chooses," he added.

The committee meets again March 15.