N.C. House passes bipartisan Medicaid expansion, bill heads to Senate

On Feb. 16, House Bill 76, a new bill to expand Medicaid, passed the N.C. House of Representatives 92-22 with large bipartisan support.

The bill, titled "Access to Healthcare Options," was sent to the Senate Rules Committee after passing its first reading in the N.C. Senate on Monday.

The primary sponsors of H.B. 76 are Reps. Donny Lambeth (R-Forsyth), Donna McDowell White (R-Johnston), Michael Wray (D-Halifax, Northampton, Warren) and Chris Humphrey (R-Greene, Jones, Lenoir). 

None of the primary sponsors responded to The Daily Tar Heel's requests for comment on the bill.

According to Jonathan Oberlander, a UNC professor of health policy and management and the chair of UNC's Department of Social Medicine, Medicaid has been contested in states like North Carolina for over a decade since the Affordable Care Act was initially passed in 2010 under the Obama administration.

Oberlander said not everyone is eligible for Medicaid in North Carolina. Those who are eligible include pregnant people, those responsible for children, people with disabilities and people over the age of 65.

"Childless adults are simply ineligible in North Carolina for Medicaid," Oberlander said. 

Since North Carolina has not expanded Medicaid, he said, there are hundreds of thousands of low-income North Carolinians who do not have access to health insurance.

Meghana Ammula is a research associate for the Medicaid and uninsured program at the Kaiser Family Foundation, a health policy analysis organization.

Ammula said, based on KFF data from 2022, over 2 million people are currently enrolled in Medicaid in North Carolina, amounting to about one-fifth of the state's population.

One part of H.B. 76, the Healthcare Access and Stabilization Program, would provide more funding to rural hospitals.

H.B. 76 is still not certain to be passed, Oberlander said, because the N.C. House and Senate disagree on "certificate of need regulations." These regulations require healthcare providers who want to expand their facilities to obtain a special certificate showing that the community needs expanded service.

Oberlander said the N.C. House, along with some medical industry stakeholders, does not want to modify these regulations, while the Senate does.

Both chambers of the General Assembly passed separate bills last year that would have expanded Medicaid access. However, neither bill was passed by the other house due to disagreements on specific provisions, including certificate of need regulations.

Oberlander said he thinks the lack of Medicaid expansion is due to political polarization between Republicans and Democrats.

One KFF study from 2019 found that almost 2.2 million people are in the coverage gap nationwide, meaning that they make too much money to be eligible for Medicaid but are still considered low-income. In 2019, 97 percent of people living in the coverage gap lived in the South.

Of the uninsured adults who would become eligible for Medicaid if it is expanded, almost three out of four live below the poverty line.

"When people who are uninsured are covered by Medicaid, we actually see reductions in mortality," Oberlander said. "So Medicaid is incredibly important to people's health and to their financial security."

Oberlander said there is a higher uninsured Medicaid rate for Black and Hispanic Americans than white Americans, and that Medicaid plays a role in reducing health insurance disparities.

"Roughly 60 percent of non-elderly Medicaid enrollees in North Carolina are people of color," Ammula said. 

Nathan Adams, a pre-med sophomore at UNC, said he thinks Medicaid is important to allow access to hospitals without putting additional financial stress on people.

"While this bill is beneficial to saving people's lives, it also benefits hospitals," Adams said.

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