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Republican legislative leaders agree on Medicaid expansion, bill now in Senate


An ambulance arrives at UNC Hospitals on Monday, March 6, 2023. Medicaid expansions will benefit patients at UNC Hospitals and other medical facilities around the North Carolina.

N.C. Rep. Tim Moore (R-Cleveland, Rutherford), the speaker of the North Carolina House, and N.C. Sen. Phil Berger (R-Guilford, Rockingham), the president pro tem of the North Carolina Senate, announced they had come to an agreement on Medicaid expansion on March 2.

House Bill 76, the House's Medicaid expansion proposal, passed on Feb. 16 with large bipartisan support. The Senate then modified the bill, adding in Medicaid coverage for people up to 133 percent of the poverty limit to start either on the passage of the 2023-24 budget or on a federally approved day.

The Senate also added workforce measures to encourage workplace participation among Medicaid enrollees and removed several healthcare services from certificate of need review. Certificate of need review requires healthcare providers who want to expand their facilities to obtain a certificate showing the community needs expanded service.

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

Rep. Pricey Harrison (D-Guilford), a co-sponsor on H.B. 76, said this expansion of Medicaid provides health care to 600,000 North Carolinians who previously were not covered, and also brings the state other benefits.

“Expanding Medicaid will create something like 40,000 jobs in North Carolina, will add billions of dollars to our economy and keep more taxpayer money in North Carolina rather than subsidizing other state's programs,” she said.

Rep. Tim Longest (D-Wake), a co-sponsor on H.B. 76, said it is important that the state Senate passes the bill as soon as possible to make sure North Carolina can benefit from the American Rescue Plan Act, which set incentives for states to expand Medicaid.

Harrison said the federal government will be covering 90 percent of the cost of the addition of the new Medicaid enrollees.

During his State of the State address on March 6, Gov. Roy Cooper said the state cannot afford to miss out on the federal benefits that come with Medicaid expansion.

"If we don't expand soon, we will forfeit an additional $1.8 billion in healthcare access and stabilization, or HASP, funds that our hospitals will never get back," Cooper said. "And that would be particularly hard on our rural hospitals. No business would make that kind of financial decision."

Ben Urick is a health services researcher who studies the connection between pharmacy and health policy at Prime Therapeutics.

He explained that the U.S. Supreme Court ruled federal coercion of state-by-state Medicaid expansion as overstepping the bounds of federalism and interfering with states' rights. States can still choose to expand Medicaid.

“Part of the provisions of the Affordable Care Act assumed that Medicaid would be expanded, and so having this instance where you can have Medicaid that is not expanded creates a real policy issue when you consider the way the law is written,” Urick said.

North Carolina is one of only 11 states in the country that has not yet moved to expand Medicaid coverage.

N.C. Rep. Carla Cunningham (D-Mecklenburg), another co-sponsor on H.B. 76 and a nurse, said those with a medical background have an easier time working on medical issues in a bipartisan fashion.

“We can step aside from our safe corners of the world and try to collaborate and come up with solutions,” she said.

Harrison said the General Assembly has made a lot of progress now that Republicans are discussing putting Medicaid in the budget.

“The combination of watching other Republican governors enact this and seeing what it was doing to our healthcare system in terms of rural hospitals shutting down, it became more and more obvious that this was something we needed to do,” she said.

In his press release regarding the announcement of Moore and Berger's agreement from March 2, Cooper said the agreement on expansion is a monumental step in the right direction.

“Since we all agree this is the right thing to do, we should make it effective now to make sure we leverage the money that will save our rural hospitals and invest in mental health,” he said.


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