Democrats call for straight-up Medicaid expansion
House and Senate Democrats called Wednesday for a quick move toward Medicaid expansion in North Carolina, making their opening play on one of the biggest-ticket items to be debated during the new legislation session.
Their plan would simply expand Medicaid, providing taxpayer-funded health insurance to hundreds of thousands of people in North Carolina, most of them the working poor. The Democratic plan is stripped free of work requirements and increased co-pays that are part of a competing plan with limited Republican support, known as Carolina Cares.
Democrats said they can expand the program to as many as 500,000 people without a hit to the state budget. The federal government would cover 90 percent of new costs, and the other 10 percent would come from hospitals around the state, which have agreed to a new assessment commonly called a “bed tax” to raise the money.
Carolina Cares also includes a bed tax.
Senate Bill 3 would expand Medicaid to anyone ages 19 to 64 whose income puts them at or below 133 percent of the federal poverty level. That’s about $16,612 for one person and about $34,250 for a family of four.
Expansion is the most impactful thing the legislature can do this year, both for health care and the state’s economy, Democrats said. The state would see an infusion of billions in the coming years in federal funding for the program.
Democrats also hit repeatedly on the state’s opioid crisis Wednesday, saying expansion money would help tackle that problem and mental health in general.
Despite Democratic gains in last November’s elections, Republicans hold majorities in both chambers of the General Assembly, and any successful expansion will need significant GOP support. House Minority Leader Darren Jackson said he is “extremely confident” an expansion plan will get out of the House, which is in line with what more optimistic Republican members who support the Carolina Cares plan have said.
The Senate is the heavier lift, and Senate President Pro Tem Phil Berger has said repeatedly that he hasn’t seen an expansion plan that doesn’t create financial problems for the state down the road. He reiterated that Wednesday as the legislature gathered in Raleigh for the 2019 session.
“My position hasn’t changed,” said Berger, R-Rockingham.
Thirty-seven other states have adopted expansion, though, including a number of Republican states.
During a press conference featuring dozens of Democrats from both chambers, several legislators acknowledged a need for compromise on the issue. Sen. Ben Clark, D-Hoke, mentioned work requirements and co-pays as likely areas of discussion.
As of now, the Democratic bill limits co-pays by requiring them to be in line with the minimal costs non-expansion Medicaid recipients pay. The Carolina Cares plan would require participants to kick in 2 percent of their annual income as an insurance premium and pay routine co-pays.
Some see work requirements as an easy point for Democrats to concede since most of the expansion population likely already works. Expansion is meant to fill a coverage gap – adults who make too much money to qualify for traditional Medicaid but not enough to get federal health insurance subsidies provided by the Affordable Care Act.
Gov. Roy Cooper, who sees expansion as a top priority, has backed work requirements for the expansion population in the past.
Legislative Democrats said they’d rather see a simple expansion, which could be in place by Nov. 1 if passed. Work requirements and other changes would require waivers from the federal government that could take months – or longer – to receive.
With the session just starting, it’s difficult to predict how the debate will go, but Cooper is likely to include expansion in the state budget proposal he rolls out in about a month. His veto has new teeth with the Republican super-majorities broken, setting up a potential budget standoff over expansion.
State government wouldn’t shut down if budget talks go past the July 1 start of fiscal 2019-20, though. State law essentially continues the old budget as is until a new deal is struck.
The health care industry is also engaged in a fight with the state treasurer and the state employee’s association that’s likely to spill into this legislative session. Treasurer Dale Folwell wants to tie rates the State Health Plan pays to what Medicare pays for the same procedures, which he has said would save the plan $300 million in the first year alone.
The industry is fighting that plan, saying it could cripple hospitals.
Democrats acknowledged Wednesday that debate and others in the health care sector might get wrapped into the expansion debate, but they also said they hope to keep things separate.
“There’s no telling where the conversation might go,” Senate Minority Leader Dan Blue said.