Supporters brace for veto on association health plans bill

Officially, Cooper hasn't laid out a position on Senate Bill 86, which was a top priority this session for the North Carolina Chamber, retailers and real estate agents across the state. But word of a veto has come more quietly to some of the people that pushed this bill the hardest.

“What we’ve heard directly from his people is that, at this time, he’s planing to veto this legislation," said Mark Zimmerman, senior vice president of external affairs for the North Carolina Realtors.

Others familiar with Cooper's thinking said the governor would like to see the measure become part of a broader conversation on health care, lumped in with Medicaid expansion. That's his own top health care priority, one that has tied up budget negotiations with the legislature's Republican majority for more than a month, delaying the state's $24-billion-a-year budget.

Pulling the trigger on a veto, though, would leave a lot of the governor's fellow Democrats with a difficult decision. The bill cleared both chambers by wide bipartisan margins. Close to half of Senate Democrats voted for it. In the House it was 19 of 55 Democrats.

“It will be a precarious position," said Rep. Derwin Montgomery, D-Forsyth, who voted for the bill.

This bill would essentially treat trade groups like large companies, letting real estate agents and other small businesses pool together under their trade associations and offer insurance plans regulated by the state Department of Insurance. These plans would have to cover pre-existing conditions but wouldn't always come with the coverage generally required by the Affordable Care Act, such as maternity care.

That was a sticking point for some legislative Democrats, and the GOP majority shot down amendments to require more robust coverage.

Zimmerman said his organization has 45,000 members and that roughly 6,000 of them say they're uninsured. Most of those say it's because of high costs, he said, and a larger group has dropped down to lesser coverage because of price concerns.

There's a lot of talk about the Medicaid coverage gap that expansion is meant to fill – people who make too much money to qualify for Medicaid, but don't make enough to get federally subsidized policies on the Affordable Care Act exchange. There's another gap higher up the income ladder, Zimmerman said: People who make too much for the subsidies but are priced out of plans available to small businesses.

“There’s really two gaps in the market, and it takes two different solutions," Zimmerman said.

The North Carolina Association of Health Underwriters sent Cooper a letter Wednesday, asking him to sign the bill and saying it will give "self-employed individuals, small business owners and gig-economy workers and their families an affordable health insurance option." The association said these are the types of people "most impacted by the 600 percent increase in the cost of individual coverage since 2015 in North Carolina."

Cooper's press office said Thursday that the governor is reviewing the bill. His decision is due this month. The governor has 10 days to act on the bill after it hits his desk.

That clock officially starts Friday, Senate Principal Clerk Sarah Lang Holland said in an email Wednesday, and expires at midnight on the final day.