NC House passed a invoice Tuesday night 101-6 that would order the state health agency to come up with a plan to modernize Medicaid. The bill sets out the tax requirements members would need to vote to expand Medicaid to about 600,000 new enrollees.
The policies described in the Rural Health Care Access and Savings Plan Act (Senate Bill 408) include work requirements for enrollees, $1 billion earmarked for behavioral health and addictions, health care expansion to rural areas, and a requirement that the state withdraw from Medicaid expansion if the federal government is going back on its promise to cover 90% of the costs.
“I’m confident that this plan has been put together in a way, with accountability and fiscal responsibility in place, if the secretary can respond to it,” Speaker Tim Moore, R-Cleveland, told the House on Tuesday. evening. “I will definitely support it and encourage my colleagues to support it, because it’s the right way to go, with these guardrails in place.”
Six months to reach an agreement
Bill authorizes Department of Health and Human Services Secretary Kody Kinsley to work with federal government Medicare and Medicaid Service Centers (CMS) to propose a specific plan to North Carolina and gives it until December 15 to present it to lawmakers. A vote would then take place on this plan.
House Democrats on Tuesday expressed concern that the requirements of the bill’s plan would be difficult to meet, asking the president if House leaders planned to defeat him.
“Are these criteria such that they are almost impossible to meet? asked Rep. William Richardson, D-Cumberland.
Moore assured him that Kinsley had agreed to the terms of the bill and believed they could be met.
“If I wanted this bill to fail, the easiest thing to do is say we’re not going to take it back, but it’s a lot of hardship to go through and a lot of hours for it to ultimately fail. “Moore said. “The beauty of it, though, is that instead of giving that blank check, we actually have the final say once the product comes back here. I think those criteria will be met.
Representative House Minority Leader Robert Reives, D-Chatham, encouraged Democrats to vote for the bill.
“I’m going to support this because I’d like to move the conversation forward,” Reives said.
“The people who are being left behind right now are working people. They work, they try and they are in a terrible hole,” he added. “If there’s a human being out there who says, ‘Hey, I have Medicaid, now I’m going to quit my job,’ I would like that person to come to my office because that would mean you would be homeless, you wouldn’t have food.If you’re homeless and don’t eat or drink, health insurance can’t save you.
During the recess between formal legislative sessions, a member-based study committee, chaired by Rep. Donny Lambeth, R-Forsyth, reviewed Medicaid expansion, speaking to health care groups and other state officials who have expanded the federal compensation program. However, the committee’s report was never completed before the state Senate passed an outright Medicaid expansion bill in May.
Senate members lobbied the House to pass their bill, but House leaders said they wanted a clearer picture of the costs and their demands met before giving consent. The House bill gives the NC DHHS six months to hammer out the details to get a vote.
“If the secretary reported something that didn’t meet the criteria, there would probably be a lot of people on this side who would vote no, and I don’t know if that would pass,” Moore said.
Some House Democrats wanted the body to also consider the Senate bill before adjourning. Governor Roy Cooper has also called for the expansion of Medicaid since taking office in 2017.
“It’s no secret that the governor didn’t like the fact that there would be votes in December,” Moore said. “I made it very clear to the governor that if there wasn’t a second vote in December on this bill, it wasn’t going anywhere in the House. So it was either like that or not. like that, just to be honest.
In other states that have expanded Medicaid under the Affordable Care Act, experts have generally underestimated the size of Medicaid expansion enrollments, underestimated its cost, and overestimated its health benefits.
What’s in the bill
The bill sets out some additional requirements of the expansion plan proposed by NCDHHS, including that, “Individuals who are not citizens of the United States will not be covered except to the extent required by federal law.” DHHS is also required to establish a system for reporting on the number of registrants, whether registrants are using preventive care, and how that impacts health outcomes.
The Obama administration has proposed work requirement waivers to allow states to impose work/volunteer requirements or a small copayment in expansion plans to encourage states to expand the program when the law on affordable care was adopted. Under the Trump administration, states that expanded Medicaid had their work waivers approved, but the Biden administration ended them. Kinsley will now have to negotiate with CMS to get them through.
The House bill also calls for $1 billion to be spent on opioids, addiction and the mental health crisis in North Carolina, “using savings from additional federal Medicaid matching available in under the American Rescue Plan Act”. ARPA is the $1.9 trillion plan passed by Congress in 2021 that economists blame for the nation’s historic rate of inflation.
Under the House legislation, a DHHS-created task force comprised of faith community leaders, law enforcement professionals, mental health experts and addiction specialists would be required to guide spending $1 billion on drug and mental health issues.
The plan also contains specific proposals to increase access to health care and preserve hospitals in rural areas of the state. Lambeth said North Carolina ranks 43rd out of 50 states for access to health care and 11 rural hospitals have closed since 2005, 19 of which are currently at risk of closing.
“Members, we have universal care in this state and in this country. It’s called the emergency room,” RIchardson said Tuesday night on the floor.
“It’s a big step forward,” he added. “I urge you to vote for this, and in December I urge you to vote for North Carolina to be part of this plan so our people can get proper health care, so they can work and not live in the emergency room.
What is NOT in the invoice
The guidelines for DHHS in the House bill do not include some of the industry reform measures the Senate proposed in its bill, including the SAVE Act, which would address needs in areas rural areas and would give more independence to nurses, and the partial repeal of certain certificates. needs requirements.
Rep. Gale Adcock, D-Wake, a registered nurse, rose to oppose the omission of the SAVE Act (House Bill 277) from the House Medicaid bill. It would allow nurses to work up to the level of their training, even if a doctor was not immediately available. It aims to address labor shortages in rural hospitals.
“I know that at least half of the members of this chamber have signed on as co-sponsors of the SAVE Act,” she said. “The SAVE Act does some really important things for this state economically.”
Adcock announced on the House floor that she wanted to file a motion for relief to have the SAVE Act heard before lawmakers leave Raleigh.
In the end, only six members of the House voted against the bill, and 101 voted for it. It now goes to the Senate for approval.
“I believe it will be a success, that we will have a product that we can all be very proud of when we vote on it in December,” Moore said.
The legislature is working to wrap up business and adjourn the short session by Saturday afternoon, July 2.