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Medicaid expansion gets a sweet reception in NC House, but uncertain audience awaits in the Senate

One of the many Medicaid expansion love notes placed by advocates in the Legislative building in Raleigh as HB76 moved swiftly through the House Health & Finance committees.
Rose Hoban, nchealthnews.com
Rose Hoban, North Carolina Health News
One of the many Medicaid expansion love notes placed by advocates in the Legislative building in Raleigh as HB76 moved swiftly through the House Health & Finance committees.

On Tuesday, North Carolina legislators kicked off what could become the final push to expand Medicaid to hundreds of thousands of low-income adults in the state with a House bill that quickly advanced through two committees with bipartisan support. To learn about the measure that appears to be heading to the Senate, BPR’s Helen caught up with North Carolina Health News founder and editor Rose Hoban.
This transcript has been edited for length and clarity.

HC: Hi Rose. It has been too long. Thank you for taking time. I know you don't have much time. So tell us where are you and what just happened.

RH: Well, I'm in the basement of the legislative building where the House Health Committee passed a Medicaid expansion bill out of their committee. And Helen, the crazy thing was I got to the legislative office building where the hearing was being held, the hallway was packed. There was a line to get into the committee room, which never happens. And then we get into the committee room and then the whole deed was done, I think in 18 minutes. Like it was almost non-controversial, they passed the bill. Representative Donny Lambeth presented the bill, and then there were a couple of comments. There was nobody objecting during the, you know, back and forth that always takes place around a bill. The vote came pretty quickly, and it was a voice vote. So we don't know how many, but it was resoundingly, yes, and only a smattering of nos in the room, and then it was done.

HC: Was the speedy passage expected?

RH: Well, we did have an indication that they were going try and move the bill quickly. Representative Lambeth said House Republicans had a three-hour caucus earlier where a law was hashed out. He said there were some objections, but the majority of House Republicans are on board with expanding at this point in time.

HC: Can we, for a moment, step back and just do a quick primer on HB76, the current Medicaid expansion bill - now under consideration?

RH: It would allow for the expansion of Medicaid to cover a lot of low income workers. Primarily these are people who make up to 133% of the federal poverty level. And that's about $19,000 in change for a single person.

I remember years ago meeting somebody in a laundromat and I said to her, "How much do you make?" And she said, "I make $12,000 a year." At that point in time, that was too much to qualify for Medicaid, but it was not enough for her to receive a subsidy under the Affordable Care Act's health insurance exchanges. What it meant for her was that she was essentially unable to find health coverage that was affordable for her in any way. So this expansion is going to cover a lot of low income workers. It'll probably cover a lot of students.

The advocates for Medicaid expansion have walked farmers and ministers and veterans around the legislative building for the past six or seven years trying to encourage lawmakers to expand Medicaid.

Then there's another part of the bill, which changes the way that hospitals get some public financing. It will mean a big boost for hospitals. The federal government will cover 90% of these people who are low-income workers, and the state has to cover the other 10%. The state is turning to hospitals to basically cover that, and the hospitals are swallowing hard and saying yes in part because they've lost so much money from people who are uninsured showing up at their doors that they've had to treat.

They're going to pay this 10% of the cost of covering these people in exchange for the state allowing  hospitals to be part of a federal program that changes the way that they receive funds for low income patients. The hospitals are getting something and the hospitals are giving something.

The third part of the bill instructs the Department of Commerce and the Department of Health and Human Services to work together to create a job development program that will help people who are unemployed and looking for Medicaid expansion coverage to get a job, or get a better job, or maybe go back to school.

HC: Thank you for that refresher. Okay, now back to the present and the bill's speedy movement through the House. In the Senate, however, that is not expected to be the case. The bill's future is unclear, right. Why?

RH: Yes, the future is uncertain. Last year, the Senate passed a Medicaid expansion bill and wrapped into that bill was one priority that the Senate has held very dearly close to their hearts for many years: reform of the state's Certificate of Need laws. These are laws that dictate the rules around hospital competition. There was also a part of the Senate bill which would give advanced practice nurses- people like nurse practitioners and midwives and nurse anesthetists-the ability to practice more independently. It was all rolled up into a big ball and passed in one bill, and then the Senate passed it. Senate leader Phil Berger has basically said that he is not going go for Medicaid expansion unless it at least includes Certificate of Need reform.

The Senate sent it to the House last year, and House Speaker Tim Moore rejected it, so that never came to a vote on the House floor.

This is not the first time that we have seen a Medicaid expansion bill be voted on the floor of one of the two chambers in the North Carolina General Assembly. The question is getting it across the line in the second chamber.

I see this as the House's initial - I guess you could put it as it's their initial bargaining gambit of accepting the employment development component, but we don't have the Certificate of Need part. It will likely be negotiated, on the Senate side.

HC: Okay. So what are your predictions about that outcome? Are you positive this go around?

RH: Oh Helen, you know better than to ask me to predict anything the legislature's going to do!

HC: <laughs>. Sorry. I know. So let's just talk about what happens next.

 RH: What we're hearing is that it will have passed the House by Thursday.

HC: Okay, well, watching the clock know you need to get back to covering this. You've actually got your own story in the works, right?

RH: I've been reading the bill for a couple days and I've been writing about it, and today I'm just going around and talking to all the people. The building is crawling with advocates, people wearing red and wearing stickers that say, "Love your neighbor, Expand Medicaid." Advocates left chocolates in the press room saying, "Wouldn't it be sweet if we expanded Medicaid?"

HC: Okay. We'll keep in touch. Thank you so much Rose Hoban for the great update and for taking the time.

RH: You're welcome, Helen. It's always a pleasure to talk to you.

About Rose Hoban:

Rose Hoban is the founder and editor of NC Health News as well as being the state government reporter. Hoban has been a registered nurse since 1992 but transitioned to journalism after earning degrees in public health policy and journalism. She's reported on science, health policy and research in NC since 2005. Contact: editor at northcarolinahealthnews.org

Helen Chickering is a host and reporter on Blue Ridge Public Radio. She joined the station in November 2014.