Medicaid expansion bill, filed in NC House, kicks off 2023 health care debate
North Carolina Republicans filed a Medicaid expansion bill in the state House Wednesday, kicking off this year’s debate over whether to extend healthcare to hundreds of thousands of the state’s working poor.
Around half a million North Carolinians would gain access to health insurance if the state expands Medicaid. Nearly every other state has already done so, through a process laid out in the Affordable Care Act.
Many of those in the so-called “coverage gap” are people who live paycheck to paycheck. Their jobs don’t give them health care benefits. And while they make too much money to qualify for Medicaid currently, they also can’t afford to buy health insurance through other means.
The bill’s lead sponsor is Republican Rep. Donny Lambeth, a retired health care executive who was an early GOP supporter of Medicaid expansion and has pushed for it for years. It has never had a better chance of passing than right now, he said — in part because the federal government is offering to pay North Carolina $1.8 billion if it expands Medicaid.
Lambeth said in an interview with WRAL News that he would’ve liked to add in a work requirement to the bill, but courts have consistently ruled those unconstitutional. Instead, he worked with Democratic Gov. Roy Cooper’s Department of Commerce to craft a part of the bill to incentivize people on Medicaid to go to community college and get re-trained for skilled trades — jobs like electricians or nurses that are in high demand, and tend to pay well.
“I’ve talked to a lot of these people over the last eight years,” Lambeth said of people who need Medicaid expansion to get insurance. “They tell me, ‘We’d rather not be on some kind of social government program, but we can’t afford it.’ … If we can help them by incentivizing them to improve their earnings power, then at some point maybe we can get them off Medicaid.”
One in every four North Carolinians is currently on Medicaid, Lambeth said, and while this bill would increase that figure at the start, he said he hopes the jobs training incentives will actually make it decrease eventually.
Advocacy groups were quick to celebrate the news.
“House Leadership has demonstrated their commitment to helping hundreds of thousands of North Carolinians who are currently in the gap, including working parents, small businesses across the state and 14,000 of our veterans,” Abby Emanuelson, executive director of Care4Carolina, said in a statement. The group is a coalition of dozens of religious, business, health care and social justice groups from around the state.
Aides to House Speaker Tim Moore said he didn't have any comment on the bill immediately, but was planning to discuss it with the rest of the GOP caucus soon. The bill is expected to move through committees and toward a vote next week.
Democrats have been the ones pushing for years for the state to expand Medicaid, although it wasn't immediately clear what party leaders thought about this specific bill.
Spokespeople for House Democrats and Democratic Gov. Roy Cooper didn't immediately respond to requests for comment.
Rep. Michael Wray, a moderate Democrat from northeastern North Carolina who is a sponsor of the bill along with Lambeth and several other Republicans, said in an email Thursday that expanding Medicaid will particularly help rural areas like his district.
Numerous rural hospitals have shut down in recent years, and recent reports have showed others remain at risk of going under.
"My main goal is to help our low income residents get access to healthcare coverage and to strengthen our healthcare providers in my district and across the state," Wray said. "This bill is a big deal and takes major steps to accomplishing those goals."
Repeating debate
Senate Leader Phil Berger for years had been one of the strongest opponents to Medicaid expansion. Last year, he said he changed his mind and now supports it.
Many other Republicans soon followed suit, and the Senate passed a bill that would have expanded Medicaid in addition to other changes they said were aimed at improving access to health care more generally.
But lobbying groups for hospitals and doctors opposed some of those extra changes the Senate tacked on. Their arguments held sway in the House last year — which wouldn’t pass the Senate’s bill.
House leadership instead preferred a simpler bill that would tackle only Medicaid expansion, without the other changes. Those had included repealing so-called certificate-of-need laws and allowing nurses with advanced training to perform more medical procedures without a doctor’s supervision.
Wednesday’s new Medicaid expansion bill in the House may show a lack of progress in negotiations, despite months of closed-door meetings between Berger, House Speaker Tim Moore and others.
The bill would expand Medicaid but makes no mention of the other changes that Senate leaders have said they are still pushing for.
Lambeth said he expects the bill to move quickly through the House, with a vote possibly as soon as Tuesday.
He acknowledged it lacks much of what Senate Republicans have said they want included in the legislation. However, he remains confident that the two chambers can come to some sort of agreement before the year is over. And there is some urgency, because the massive $1.8 billion signing bonus being offered by the federal government could evaporate at any time.
“You don’t have to use it for health care,” said Lambeth, who is also one of the state’s top budget writers. “You can use it for education. You can use it for other critical state needs. … My idea around it is to use it for some mental health ideas that I’ve got around reforming our mental health system.”
