North Carolina legislators took an initial step Tuesday toward expanding Medicaid coverage to more working families after nearly a decade of Republican opposition when a GOP-designed plan easily passed a committee with bipartisan support.
The legislation approved by the House Health Committee requires participants to work and pay up to 2% of their annual household income for coverage. That, along with an estimated $2 billion from hospitals hoping to cut the volume of poor people who can't pay, would cover the state's share without costing taxpayers, said state Rep. Donny Lambeth, a Forsyth County Republican and former hospital executive.
"We have a problem with health care in North Carolina" that includes more than 1 million residents without insurance coverage, struggling rural hospitals and small communities unable to attract doctors as an aging population increases demand, Lambeth said. The plan assumes about 300,000 would qualify for expanded Medicaid coverage, he said.
North Carolina is one of 14 states that have resisted Medicaid expansion covering roughly 12 million people despite the federal government paying 90% of Medicaid expansion costs under provisions of the Affordable Care Act, nicknamed Obamacare.
That law faced a legal challenge Tuesday in a federal appeals court in New Orleans from Republican-led states arguing that all facets of the law must be voided because Congress dropped tax penalties for people who don't buy health insurance coverage. Any decision by three-judge panel of the 5th U.S. Circuit Court of Appeals panel will likely be appealed to the U.S. Supreme Court.
Republican House leaders allowed the North Carolina legislation, building on proposals first advanced in 2017, to get a committee vote amid a budget fight in which Medicaid expansion looms large.
Democratic Gov. Roy Cooper wants Medicaid expansion without work requirements or premiums and he vetoed the state budget plan adopted by the Legislature because Republicans didn't include it.
Senate leader Phil Berger, a Rockingham County Republican, said he won't negotiate with Cooper over the budget unless the governor drops his Medicaid demand. "We're willing to have a conversation about health care. It's just that for the governor to hold up the entire budget on that one issue strikes me as something that's just totally inappropriate," Berger said Tuesday.
Berger said the Medicaid expansion bill being considered by the House lacked the votes to pass in the Senate.
Cooper called the Republican decision to begin consideration of Medicaid expansion "a good step forward" but short of his proposal that would expand Medicaid to between 500,000 and 600,000 working North Carolinians.
"Clearly if they're discussing it, they realize that it's an important part of this process, but it has to go through two chambers in order to pass," he told reporters Tuesday.
The expansion proposal advanced Tuesday was opposed by advocacy groups on the left, which argued work and reporting requirements are expensive and complicated, and the right, which said accepting more federal funding for Medicaid would add to the national deficit.
But supporters addressing legislators included the owner of daycare centers who said her poorly paid teachers suffered without affordable health care and former Republican gubernatorial candidate George Little, who said North Carolina businesses couldn't remain competitive without financially stable hospitals.
Cassandra Brooks, who owns two daycare centers near Raleigh, said two of her teachers died prematurely from heart ailments that went untreated because they couldn't afford medical costs, a problem Medicaid expansion could address.
"They died from something so simple that could have been prevented," she said.