More than half a million North Carolinians make too much money to qualify for government health care coverage through Medicaid but earn too little to get a credit to purchase health insurance on the government exchange. For these residents "in the gap," medical coverage can be costly, often resulting in mounting medical debt.
A bill that would expand Medicaid in the state is in the hands of the Senate after the measure passed the House last week. North Carolina is one of only 12 states to declined to implement expansion since the passage of the Affordable Care Act in 2010. Now the Senate must consider what trade-offs might make the bill palatable to some Republicans who have opposed the expansion for years.
Republican Senator Kevin Corbin, chairman of the Health Care committee, represents district 50 which includes Cherokee, Clay, Macon and Graham Counties. Many of his constituents currently fall in the coverage gap. Corbin, who served two terms in the House before his time in the Senate, said he was ahead of his Republican colleagues in advocating for expansion.
"I have been a proponent of expanding Medicaid for probably about four years now that I've been in the General Assembly," he said. "And overall general widespread support of it has not really come about until the last couple of years."
The change could happen this year with GOP leadership backing the measure, he said. The biggest reason for Republicans change of heart has been the state’s 2022 Medicaid transformation process, according to Corbin.
"I think over a period of time managed care has made a difference in the perception of Medicaid," he said. "I mean, everybody knows somebody in their family, somebody they go to church with, somebody that they are familiar with, that is a hard working North Carolinian that simply just doesn't make enough money to qualify for a tax credit."
Corbin co-sponsored the Senate’s May 2022 expansion bill. The current bill differs from last year’s measure in two key ways: the new bill removes the workforce requirements and the addendums to the state’s “certificate of need” policy.
Republican Rep. Donny Lambeth who sponsored the House bill told WRAL that there is now an understanding that workforce requirements are not allowed based on federal regulations. The compromise is a workforce development section of the bill that encourages job training.
The change from workforce requirements to a section encouraging workforce development will probably go over well in the Senate, Corbin said.
"You can't really put a straight work requirement, but I think you can put some things in there about workforce development and making sure that folks have all the provisions they need to get jobs," he said. "And frankly, a lot of the people that will be added to Medicaid will be folks that work now, folks that have jobs, folks that earn a living. These are not unemployed people."
The certificate of need process is what healthcare providers have to do to get regulatory approval from the state to build new facilities or offer new services.
Corbin says Senate Republicans are still interested in changing the policy but it doesn’t necessarily have to be part of Medicaid Expansion.
"I think the Senate is probably going to look at putting some type of certificate of need revisions in there," he said. "We think that it is needed to increase competition and hopefully we'll provide more services for rural North Carolina."
Updating some of the policy is necessary, but there is a need to maintain sections pertaining to acute care hospitals in rural regions, he said.
Three Western North Carolina counties-Yancey, Swain, and Transylvania- are among the top places in the state with nonelderly populations living in the gap, according to the NC Justice Center.
