North Carolina Senate Rejects Medicaid Expansion
A rarely used state Senate rule and growing concerns over the potential cost of providing health care to tens of thousands of additional low-income residents in North Carolina stymied efforts to enact Medicaid expansion in this year’s legislative session.
The state Senate, by a 38-8 vote in March, approved bipartisan legislation allowing small businesses to band together and buy cheaper health insurance, after defeating efforts by Democrats to add a multibillion-dollar Medicaid expansion to the bill.
Expanding Medicaid has been a top priority for Gov. Roy Cooper and his fellow Democrats in the legislature. Senate Republicans, who hold a majority, tabled a Medicaid expansion amendment to the small-business insurance-pool bill. Under a North Carolina Senate rule, once a bill or amendment has been tabled, it cannot be brought back up in the session in progress.
Expansion Debate Could Continue
Medicaid expansion could resurface in the larger budget debate later this year.
Statehouse observers speculate Cooper might veto any budget that doesn’t include Medicaid expansion. As a result of last November’s midterm election, Republicans no longer have veto-proof supermajorities in the legislature.
Further complicating the situation is legislation recently introduced in the House by Rep. Donny Lambeth (R-Forsyth) designed to provide an alternative to Medicaid expansion.
Lambeth’s bill, to provide coverage for additional low-income residents would remove state taxpayers from the equation by requiring able-bodied adult recipients to work and pay premiums and hospitals and health care providers to pay the rest through assessments. Work requirements in Arkansas and Kentucky for Medicaid were recently struck down by a federal judge so legality of the bill is uncertain. Lambeth’s measure would also require participants to get routine physicals and screenings.
Under the 2012 U.S. Supreme Court ruling on the Patient Protection and Affordable Care Act (ACA), commonly known as Obamacare, states may expand Medicaid coverage to people earning up to 138 percent of the federal poverty level, which is $16,642 per year for individuals or $33,984 for a family of four. North Carolina is one of 18 states that have not done so.
Trouble in Other States
A study by the North Carolina-based John Locke Foundation foundstates that have opted for Medicaid expansion have been saddled with spiraling costs that have severely strained their budgets.
In Arizona, which expanded Medicaid in 2002, “the expanded population (mostly childless adults) ended up costing two to four times the cost of covering low-income parents,” the study states. “Similar outcomes occurred in other expansion states, including Oregon, Delaware, Maine, Washington, D.C., Utah, and Vermont.”
“Medicaid expansion would cost North Carolina an estimated $6 billion between 2020 and 2039,” the study states. “To pay for the expansion, the North Carolina General Assembly would need to reduce provider payments, divert resources from other important parts of the budget such as education or transportation, or greatly increase taxes.”
“Our Medicaid program already covers over two million of the state’s children, disabled, elderly, and low-income mothers,” Jordan Roberts, a health care analyst at the John Locke Foundation, told Health Care News. “Legislators should leave the program for the intended population rather than adding an estimated 500,000 individuals, the majority of whom are abled-bodied, working-age, childless adults.”
Bonner R. Cohen, Ph.D.,(email@example.com)is a senior fellow at the National Center for Public Policy Research and a senior policy analyst with the Committee for a Constructive Tomorrow (CFACT).
North Carolina Gov. Roy Cooper
North Carolina state Rep. Donny Lambeth (R-Forsyth)
North Carolina H.B. 655, “NC Health Care for Working Families,” April 9, 2019
Sponsored by Rep. Lambeth, Murphy, Dobson, White
North Carolina Policy Solutions 2018, John Locke Foundation