One obstacle cleared, but a big one remains for NC Medicaid expansion

·4 min read
Ethan Hyman/ehyman@newsobserver.com

For a long time, those pushing for North Carolina to expand Medicaid thought the biggest obstacle would be getting Senate leader Phil Berger and his Republican caucus on board.

Berger and top Senate Republicans have now joined the chorus of lawmakers advocating for Medicaid expansion, introducing a major health care package Wednesday and calling it “good state fiscal policy.”

“If there is a person in North Carolina who has spoken out against Medicaid expansion more than I have, I’d like to meet that person,” Berger said at Wednesday’s press conference. “In fact, I’d like to talk to that person about why my view on this has changed, because I think this is the right thing for us to do.”

Maybe he should start with his colleagues in the House.

House Speaker Tim Moore told reporters Wednesday that it won’t be happening this year. It’s a “contentious issue” and he doesn’t “see an appetite for it right now” in his caucus, he said.

Historically, the House has not been the chamber to take the harder line on something resembling Medicaid expansion. Over the years, they’ve floated proposals that would offer coverage to more people, albeit with small premiums and work requirements.

“It’s deeply strange. It’s like the parties in the House and the Senate have switched places in the last two years,” state Sen. Jeff Jackson, a Democrat from Mecklenburg County, told the Editorial Board. “It used to be that the Senate was the problem, and the House was basically for it. And now that appears to have switched. It’s not really clear to me why that’s the case.”

Unlike the Senate, many House Republicans aren’t as convinced that it doesn’t pose a fiscal risk to the state. Some still worry what burdens might be placed on the state’s budget if the federal government were to reduce its share of the costs.

“People aren’t sure about what that’s going to do to the state, how much the state’s going to be on the hook for,” attorney and Republican consultant Larry Shaheen said. “There’s just a lot of questions that are still out there. And I think that’s kind of what’s holding them back.”

The way the legislation was presented doesn’t seem to be helping. The bill would do other things, too, like allow advanced practice nurses to practice without physician supervision. Such a policy has had mixed support among House Republicans, and is opposed by many health care providers.

House Republicans also were under the impression that nothing would move forward until a joint legislative oversight committee, which was created last year to study Medicaid expansion, presented its findings and recommendations, Shaheen said. That hasn’t happened yet.

“Jumping the gun a little bit on this probably wasn’t the wisest decision,” Shaheen said.

Only a fraction of House Republicans need to support the legislation for it to pass, technically speaking. Assuming every Democrat votes for it, only about a dozen Republicans would need to join them. There are currently 69 Republicans serving in the House.

But whether a bill actually makes it to the House floor for a vote is at the discretion of Moore and other top Republicans. It’s not uncommon for legislation to fizzle out if the majority party doesn’t enthusiastically support it.

The result: As significant as it is for the Senate to finally support Medicaid expansion, it doesn’t make much of a difference in the end. It certainly doesn’t change much for the 600,000 people still stuck in the coverage gap: unable to qualify for Medicaid, unable to afford health insurance on their own.

There’s a real cost to waiting to expand Medicaid, and it’s not just the billions of federal dollars that legislators have passed up over the years. Research suggests that expanding Medicaid could save the lives of more than 1,000 North Carolinians each year. That’s 1,000 more lives that won’t be saved if the legislature closes yet another session with unfinished business.

The path to Medicaid expansion may have cleared one major obstacle, but there’s still plenty that’s standing in the way. We can thank the House for that.

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