North Carolina may finally be on the verge of finding its “compassion and common sense” in the words of Mary Scott Winstead, spokeswoman for Gov. Roy Cooper. Winstead’s remark, made in an email to the Associated Press, disparaged the fact that North Carolina is one of the last states that haven’t extended Medicaid coverage to hundreds of thousands of people eligible under a federal program that would pay 90 percent of the cost.
That may be about to change. A bill to expand Medicaid coverage easily gained approval in the state House earlier this week. But the bill could still falter in the Senate over a disagreement among Republican lawmakers about whether to saddle it with other changes to the health care system that are opposed by hospitals and doctors.
Rep. Donny Lambeth, R-Forsyth, a retired Health care executive, filed House Bill 76, Access to Health Care Options Feb. 9. The Department of Health and Human Services estimates it would extend health care coverage to as many as 600,000 low-income uninsured North Carolinians.
A similar bill, passed in the Senate
last year, failed in the House because it contained provisions that would repeal North Carolina’s certificate-of-need rules and would allow nurses with advanced training to perform more medical procedures without a doctor’s supervision. Opposition from lobbies for doctors and hospitals killed that bill. Lambeth’s bill doesn’t contain those provisions but they could be added in the Senate, where Senate leader Phil Berger has made his support for Medicaid expansion contingent on them in the past.
Those changes to the health care system are separate issues that should be decided on their merits, just as
Medicaid expansion should be decided on its merit. And if lawmakers ever encountered an incontrovertible choice, expanding Medicaid is it.
The federal government will pay 90 percent of the cost. A section of Lambeth’s bill would implement the Healthcare Access and Stabilization Program, which would increase the amount hospitals ar
e paid to care for Medicaid patients to an amount closer to the actual cost. In return, hospitals and health care plans would cover the remaining 10 percent.
According to Lambeth, about 70 percent of those who would qualify for coverage if Medicaid is expanded already work, including many nursing home, home health, childcare, restaurant, hotel and grocery employees. Instead of establishing a work requirement, something the courts have struck down in other states, Lambeth’s bill creates a comprehensive workforce development program called NC Health Works that would match recipients with training and job opportunities. This section is modeled on a similar program in Montana where 78 percent of unemployed participants found employment after completing the program, according to a report prepared for the Montana Healthcare Foundation.
The economic benefit of reduced sick time and increased productivity resulting from a healthier workforce can’t be easily measured, but job growth can be. A report in Michigan found that new economic activity associated with expanded Medicaid spending resulted in the creation of 30,000 new jobs.
“Our analysis suggests that for individual states … there are economic benefits to the state and state government that far outweigh the cost of … Medicaid expansion,” Dr. John Ayanian, said in a 2017 interview with New England Journal of Medicine Managing Editor Stephen Morrissey. Ayanian, director of the University of Michigan Institute for Health Care Policy and Innovation, said about one-third of the new jobs were in the health care industry. The remainder were created in other sectors as health care spending flowed through the economy and caused a multiplier effect. The additional spending netted the Michigan government an additional $150 million in sales tax and income revenue.
Medicaid was signed into law in 1965 along with the law that created Medicare. All states have Medicaid health coverage for some low-income people. The federal government pays about 70 percent and requires states to make it available to certain groups. States have considerable discretion at setting income eligibility levels. To qualify in North Carolina you must be a caregiver for a child 18 years of age or younger or a disabled family member and make less than 40 percent of the federal poverty level. Or you must be blind, have a disability, or be older than age 65 and have an income of less than 100 percent of the federal poverty level. Non-disabled, childless adults ages 19-64 are not eligible for Medicaid coverage.
Beginning in 2014, the Affordable Care Act offered states the option to expand eligibility for Medicaid to all persons with an annual income of less than 138 percent of the federal poverty level. For 2023, the income threshold to qualify for a single person would be $20,120.
The COVID-19 relief bill passed in March 2021 included financial enticements for North Carolina and the other holdout states to expand Medicaid. If it does so, North Carolina could get $1.5 billion or more as a signing bonus. Some lawmakers are talking about using $1 billion of that to shore up the state’s pitifully inadequate mental health system. But the bonus comes with the condition that states agree not to put stipulations on enrollees. A workforce amendment added to the bill creates a contingency that requires the state to develop a work requirement plan if the federal government should authorize it. That may disqualify North Carolina from getting the bonus. That would be an outrageous case of politics trumping good judgment.
North Carolina taxpayers paid their share of the federal money being used to fund Medicaid expansion and they deserve to have their share of those tax dollars returned to benefit our state. North Carolina can increase federal funding for health care by $8 billion annually and potentially an additional $1.5 billion one-time signing bonus by expanding Medicaid and implementing the Hospital Access and Stabilization Program.
There can be no justification for burdening a bill that so obviously benefits so many people in North Carolina, at virtually no cost to the general fund, with controversial amendments that have already scuttled it once. North Carolina is one of 11 states that have not adopted Medicaid expansion. It’s long past time for North Carolina lawmakers to choose “compassion and common sense.”
Joy Franklin is a journalist and writer who served as editorial page editor of the Asheville Citizen-Times for 10 years. Prior to that she served as executive editor of the Times-News in Hendersonville, N.C. Franklin writes for Carolina Commentary.