What to know about the new Republican Medicaid expansion agreement
Republican leaders in the legislature have reached an agreement to expand North Carolina's Medicaid program. Medicaid provides health insurance to more than 2 million low-income people across the state.
The expansion is expected to add an estimated 600,000 people who have been living without health insurance.
WUNC's Will Michaels spoke with WUNC Capitol Bureau Chief Colin Campbell who was at the announcement.
This conversation has been lightly edited for clarity and brevity.
Will Michaels: This is big news. Republicans had been historically opposed to Medicaid expansion when the Affordable Care Act gave states the option to do so in 2010. What's changed?
Colin Campbell: Yeah, I think over time, you've seen other Republican states, jump on board and expand Medicaid there. And Republicans here had been watching that closely to see what the budget impact was. You know, the initial concern was, 'Oh, the federal government's gonna give us all this money now to do this. But what if they changed their mind later on, and then we're stuck holding the bag as far as that goes?' There's also some concerns about the stability of the Medicaid program in North Carolina. They had a deficit for a while. Now, that's going pretty well, and so they feel pretty comfortable about expanding it to another half million or so people.
Michaels: Give us a brief rundown what is in this agreement.
Campbell: The key provision of this is that it will expand Medicaid, starting sometime this summer. It's a targeted to start when the budget passes, which is usually a few months out from now. The other provisions involve changes to healthcare regulations known as Certificate of Need. [It] also has some provisions about other federal funding for hospitals and other medical providers that the state needs to enact on our end here in North Carolina in order to get those federal dollars flowing through.
Michaels: On the financial side of things, how much money will North Carolina get from the federal government as an incentive to expand Medicaid?
Campbell: Yes, so there's this sort of signing bonus that the federal government has put out there to get more states on board with Medicaid expansion. And that's about a billion and a half dollars to support various sorts of mental health, public safety, rural health care, a variety of other things that the state will have to figure out exactly how it wants to spend. State Department of Health and Human Resources says between the two different programs expansion and the thing known as HASP, which is this additional funding for medical providers, we're talking about an additional $8 billion coming into North Carolina, both to the government and to healthcare providers. And that's huge in a state where our total state budget is about $28 billion. So this is a big chunk of change.
Michaels: Let's talk about Certificates of Need a little bit. Can you explain what those are and why some lawmakers wanted to do away with them?
Campbell: So essentially, North Carolina has what might seem like odd regulations where if you want to build a new hospital, a new medical facility of some kind, you have to apply for a certificate from the state. And they have to open it up to other providers that might want to open a similar facility in the same area. And if you've got two or more that want to be there, they have to compete, and only one of them usually gets the ability to open that. So the Senate has long wanted to do away with that entirely. This is sort of a smaller step in that direction by getting rid of it for certain types of facilities, such as surgical centers in urban areas, mental health facilities, substance abuse, addiction, treatment facilities, and a couple other categories of permits that normally are required under the current law.
Michaels: Are health systems likely to support that?
Campbell: So they have put out a statement as of today in support of the deal. They had a compromise offer that they put out last fall that the Senate initially didn't go for. So this is essentially a continuation of those negotiations. And my understanding is that all of these parties came together in the last couple of weeks to say yes to this particular compromise.
Michaels: And how are Governor Roy Cooper and his fellow Democrats responding to it?
Campbell: Really positive as you can imagine. Governor Roy Cooper has made Medicaid expansion a pretty big priority from him since day one of the administration which was, you know, six years ago, essentially at this point. He says he'd like to see Medicaid expansion take effect immediately upon passage of the bill rather than waiting for the budget this summer. Republicans say that wait is necessary because the budget may deal with some of the financial aspects of this that need to come together all at once.