Medicaid expansion panel eyes worker shortages, hospitals

RALEIGH, N.C. (AP) — A study panel that could serve as the glidepath for the General Assembly to accept broad Medicaid expansion in North Carolina a decade after it was first offered met for the first time Friday.

The Joint Legislative Committee on Access to Healthcare and Medicaid Expansion was created in the state budget approved in November.

When Democratic Gov. Roy Cooper, a longtime expansion advocate, and Republican lawmakers couldn’t negotiate a budget agreement that contained coverage to hundreds of thousands of additional low-income adults, the study committee was inserted as a substitute.

The panel, which is likely to meet for several months, will consider other topics beyond expansion that discourage health care services. Friday’s meeting also looked at addressing “surprise billing” by out-of-network providers, shortages in primary care workers and nurses, and struggling rural hospitals.

Rep. Donny Lambeth, a Forsyth County Republican and the committee’s co-chairman, said he’s hopeful that several months of meetings will result in a wide-ranging health care package — including expansion — that could be voted on by the full General Assembly in September or October. Many Republicans remain skeptical of expansion, however.

“Our role is to try to get facts on the table and help you be an informed legislator so that at some point we can debate some of the decisions and recommendations that we do want to make,” Lambeth told colleagues.

North Carolina is among 12 states that haven’t expanded Medicaid as allowed under the 2010 federal health care law.

Republicans in charge of the General Assembly since 2011 have been skeptical of expansion for years. They were worried about the fiscal health of traditional Medicaid coverage or whether the federal government’s 90% share of covering the uninsured would stay in place under expansion.

But support has slowly grown within the GOP amid persistent lobbying by a conglomeration of health care and social service advocates and local government officials.

About 2.7 million North Carolina residents are now covered by Medicaid. Expansion could add another roughly 400,000 to 600,000.

“We look forward to making 2022 the year we close the coverage gap for all those without an affordable option for health insurance,” Erica Smith Palmer with Care4Carolina, a pro-expansion organization, said in a news release.

The 2021 federal COVID-19 relief law would give the dozen states that haven’t accepted expanded coverage more money to cover traditional Medicaid patients through 2023 if they sign up. That would result in an additional $1.5 billion to $2 billion in additional federal funding, according to information the National Conference of State Legislatures provided to the committee on Friday.

An effort by some House Republicans in 2019 to expand coverage fizzled when it became clear a proposed work requirement for expansion recipients faced legal scrutiny.

In 2021, longtime expansion opponent Senate leader Phil Berger, a Republican, said he was now willing to accept expansion as part of the lengthy budget negotiations with Cooper.

But Republican House Speaker Tim Moore said there wasn’t enough support among party members in the chamber.

“We’re not lukewarm yet in the House. It is still rather chilly,” Lambeth said after Friday’s meeting. “It is a heavy lift to convince our House caucus that this is the right direction to go. Now, is it impossible? No, I wouldn’t be here if I thought it was impossible.”

Berger also said this week that he could envision an expansion vote before the November elections.

The NCSL said in its presentation that states that have expanded Medicaid saw minimal fiscal impact, more financially stable hospitals, improved substance abuse treatment and earlier cancer detection and treatment. But it may have led to waiting times for some services, the group said.