NC House backs Medicaid expansion by wide margin, putting ball in state Senate's court

The North Carolina House backed Medicaid expansion in the state, taking a bipartisan step Wednesday in a long-debated move that would extend federally-funded health insurance to hundreds of thousands of people.

Crucial negotiations must bridge a seemingly large gulf before anything is final. Nonetheless, expansion supporters are hopeful that North Carolina, one of 11 states that hasn’t passed expansion since the federal Affordable Care Act created it in 2010, will do so this year.

The vote on House Bill 76 was 96-23, a lopsided vote emblematic of the dramatic change of heart that the legislature’s Republican majority has had on this proposal, which would pump billions of dollars into the state’s healthcare systems.

GOP lawmakers blocked expansion for years but came around as rural hospitals struggled to stay open without the extra funding and the program survived legal challenges at the national level, signaling it's here to stay.

House rules require another vote, slated for tomorrow, before the measure moves to the Senate. Senate leadership also backs expansion but has a much different plan, setting up a conflict similar to the one that derailed expansion last year.

Senate Republicans have insisted on regulatory changes meant to boost competition in the health sector and make new room for the hundreds of thousands of people who would get insurance with expansion. The state’s hospitals and doctors generally oppose those measures, fearing it will bite into their bottom lines as state rules limiting new imaging centers and other money-makers in the health care sector are eroded.

The House has backed hospitals and doctors on this, leaving regulatory rollbacks out of its bill. Senate Republican Leader Phil Berger, R-Rockingham, has said repeatedly that the bill won’t pass his chamber without them.

Negotiations come next, with an unclear timetable. Democratic Gov. Roy Cooper has called for quick action, saying the state foregoes more than $500 million a month by delaying. House Democratic Leader Robert Reives, D-Chatham, said that he was proud to vote for the bill and called Wednesday "a good day for working families in our state."

If expansion becomes law, the federal government would pay for 90% of the new costs, with hospitals and insurance companies covering the rest, partly through pass-through taxes and partly from another new source of federal funding layered into the House bill: Healthcare Access and Stabilization Program (HASP) payments.

Altogether, the state estimates the federal cash infusion from expansion and HASP around $8 billion a year.

State Rep. Donny Lambeth, a former hospital executive, has pushed his colleagues to embrace expansion for years. Lambeth, R-Forsyth, said this week it will help an estimated 600,000 people, some 80% of whom have a job that doesn’t come with insurance, leaving them in a coverage gap.

They make too much money to qualify for government insurance under North Carolina’s restrictive rules, but not enough to pay for it themselves.

The House added three amendments to the bill Wednesday. One keeps hope alive for a work requirement tied to expansion. Republican lawmakers have wanted to provide the expanded insurance only to people with jobs, but a federal court struck down that requirement from another state.

This amendment says that if work requirements become permissible, the state will work with the federal government to implement one. The vote was 77-41, with most Democrats voting against the change. It was sponsored by state Rep. Keith Kidwell, R-Beaufort and one of the House’s most conservative members, who voted against the overall bill.

The House also added $50 million to the bill Wednesday to cover administrative costs in county offices that will determine whether people qualify for the program. That vote was unanimous.

A final amendment added $14.4 million to begin a forgivable loan program to entice young doctors to work in rural areas in exchange for a free education. That vote was also unanimous. Lambeth has said he’d like to see other efforts added to the state budget to encourage more people to enter the health care industry.