North Carolina Legislature Delays Medicaid Expansion Agreement

RALLY, NC (AP) – General Assembly leaders acknowledged Tuesday that North Carolina’s compromise to finally embrace Medicaid’s expansion likely won’t come quickly, commenting success for an agreement in the near future in part on buying from a major health care interest group.


What you need to know

  • Both the House and Senate passed bills to expand Medicaid, but the two chambers disagreed on additional changes to state rules for hospitals and the practice of highly trained nurses.
  • Senate leader Phil Berger has expressed pessimism about the settlement by the end of the year, after which new lawmakers will be sworn in.
  • North Carolina is one of 12 states that have not accepted a Medicaid expansion since Congress offered it more than a decade ago.

Senate Speaker Phil Berger and House Speaker Tim Moore spoke separately to reporters while the legislature convened this week for no-vote sessions, and said high-level discussions have waned since her main term of office for the year ended 3-1/2 weeks ago.

By that time, the Republican-controlled House and Senate had passed various legislation that set the state on a path to accepting federal funds to cover 90% of the medical expenses of up to 600,000 low-income adults who earn a lot from traditional Medicaid. . North Carolina is one of 12 states that have not accepted expansion since Congress first introduced it more than a decade ago.

Senate proposal supported by Berger He agreed to the expansion, but it also contained additional reforms that he said would increase the number of service providers and services. It included cutting back “certificate of need” laws that tightly regulate expansion plans by medical providers and allow highly trained nurses to practice without physician supervision.

The House plan ruled out those additional reforms, instead envisioning the legislature returning in mid-December to vote on an expansion plan developed by the Democratic Governor Roy Cooper administration that contains several key financial and medical criteria.

“The bill that the Senate sent in is just an unsuccessful one,” Moore said. But Berger said his room would accept not only a measure that includes an expansion, but one that includes some “supply-side increases” for health care providers and medical facilities. Berger blamed state hospitals for their failure to accept the recall of the Need Laws certificate.

“There is still a window to get something done,” he told reporters. “But quite frankly, as long as hospitals remain stubborn as they are, I don’t see that we are going to make any progress.”

The North Carolina Healthcare Associationwhich represents for-profit and nonprofit hospitals, said Tuesday that it looks forward to continuing to work with House and Senate leaders to advance expansion and enter into a program that would allow hospitals to receive higher Medicaid reimbursement rates.

In an emailed statement, NCHA spokeswoman Cynthia Charles said the group told Berger that “elements of the Senate bill would harm hospitals and undermine the state’s safety net.”

As evidence of the association’s impact, Moore said he wants to make sure hospitals approve the Certificate of Need Changes before his room votes on it.

“I think we need to be very careful (with) the people trying to blame the hospitals,” he said. “These are the facilities that are on the front lines, looking after the sickest patients in our state.”

While proponents of certificate of need laws say they prevent the use of expensive medical services from getting out of balance with demand, critics say they limit competition, to the financial benefit of existing health care providers.

Cooper, who is a staunch supporter of Medicaid expansion and will be required to sign any final law, told reporters earlier this month that he hoped for a quick agreement on the expansion.

Moore said Tuesday there was no need to rush to find a solution. The legislature is already set to return monthly for the rest of the year – the next meeting on August 23 – to address other potential topics. So there are opportunities to vote on any expansion agreement that surface. Berger is currently pessimistic about a compromise by the end of the year, after which a new group of 170 lawmakers will be sworn in.

The agreement couldn’t come soon enough for participants in a Tuesday morning vigil outside the legislative building. They named by name North Carolina residents who said they died of severe illness while lacking Medicaid or insurance coverage.

“I am angry, sad and frustrated that we have to be here again today and have another vigil and beg lawmakers to do the right thing and expand Medicaid,” said Rebecca Siris of the North Carolina Justice Center. “Health care can’t wait. When you wait – I’ve heard – people die.”

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