By Rose Hoban and Rachel Crumpler
It finally happened.
In a move that many health care advocates have been pushing for years, the state Senate introduced a bill on Wednesday that would expand the state’s Medicaid program to some half million-plus low-income North Carolinians.
Until this point, Medicaid has been reserved mostly for children from low-income families along with a small number of parents in those families, poor seniors and people with disabilities. Since 2012, the possibility to sweep in many low-income workers has been on the table as a result of the Affordable Care Act, but Republican leaders in the state senate have been staunch opponents.
Now, after years of saying no, powerful Republicans in the state Senate are saying yes.
“Why now? Why this? First, we need coverage in North Carolina for the working poor,” said state Senate leader Phil Berger (R-Eden), who admitted during a press conference Wednesday that he has likely been the most outspoken person in the state about his opposition to Medicaid expansion.
“Second, there is no fiscal risk to the state budget moving forward with this proposal,” Berger added, noting that the bill includes pay-fors that would have hospitals largely on the hook to pay the 10 percent of the costs for the expansion population not covered by an enhanced federal payment. There’s also a federal incentive that would total some $1.5 billion in extra funds that would flow to North Carolina over a two-year period.
Finally, he argued that since the state has moved Medicaid from being a state-run fee-for-service program to one managed by commercial insurance companies, the program has been “reformed and transformed.”
“Medicaid expansion has now evolved to a point that it is good state fiscal policy,” Berger continued. “But again, I cannot emphasize this enough: Expanding Medicaid needs to happen with additional reforms.”
Those reforms could make the bill to be titled Expanding Access to Healthcare in North Carolina a hard pill for many to swallow. One aspect of the bill would set up a work requirement for the new beneficiaries, something that’s been repeatedly struck down in other states by federal judges.
What really might jeopardize passage of the bill is that it contains provisions that already are raising hackles in some powerful health care lobbies, including those that advocate for the state’s physicians and hospitals.
Resistance from doctors
One reform proposed in the 33-page bill would make it possible for advanced practice nurses such as nurse practitioners, nurse midwives and certified registered nurse anesthetists (CRNAs) to practice without having a contract with a physician for their supervision.
Physician and nursing groups have been divided over the so-called SAVE Act for years, with medical providers — led by the North Carolina Medical Society — usually being able to stop the nurses from having more leeway in their practices. At a Senate Health Care Committee hearing held after the press conference, several Democratic lawmakers also expressed reservations over this part of the bill.
Chip Baggett, head of the
