Raleigh, N.C. — Here’s a multibillion-dollar question as the General Assembly comes back into session: Will North Carolina expand Medicaid this year?
Rep. Donny Lambeth, R-Forsyth, a senior appropriations chairman and someone who has supported a modified expansion plan for years, put the chances at 50/50 Wednesday.
He’s pitched a plan called “Carolina Cares” since 2017.
The bill sat in committee the last two years. But Democrats broke Republican super-majorities in the House and Senate in November’s elections. Republicans maintain comfortable majorities, but suddenly Gov. Roy Cooper’s veto has new meaning, giving him more negotiating power.
Cooper is almost certain to put expansion in his budget proposal when it rolls out around March 1, setting up a stalemate if the majority of Republicans in either chamber continue to oppose the plan over long-standing cost concerns.
House Speaker Tim Moore said House members are “having a lot of conversations about the Carolina Cares approach that Rep. Lambeth has worked on.
“If there’s something that we can do to help the working poor, I think that’s something that we ought to try doing,” said Moore, R-Cleveland.
The Senate has always been the bigger lift for this plan, and Senate President Pro Tem Phil Berger remains unmoved.
“I think we will continue to talk about Medicaid expansion,” said Berger, R-Rockingham. “Me personally, I’ve yet to see a specific proposal on Medicaid expansion that, in my view, does not create significant fiscal hurdles for the state down the road. And that, for me, is kind of the key.”
Expansion would extend taxpayer-funded health insurance to hundreds of thousands of people in North Carolina, most of them the working poor. Thirty-six states have done some sort of expansion, including Virginia last year after Republicans barely retained their legislative majorities there.
Carolina Cares would cover people earning 133 percent of the federal poverty level or less. It includes a number of measures meant to make the program more palatable to Republicans: Participants would generally pay an annual premium set at 2 percent of their household income, and there would be work requirements with some exceptions.
The bill had five House Republican sponsors last year, and all five won re-election.
Most expansion costs are borne by U.S. taxpayers, but state governments have to put up matching funds. The state portion under Carolina Cares would be funded by a hospital assessment, often called a bed tax.
Lambeth said state projections show the plan saving state government millions as the need to subsidize health care through other programs diminishes. He said Cooper has asked him to meet on the issue in early February.
“It has literally zero state money,” Lambeth said.
Other Republicans have concerns about the future, though, and whether the federal government will make good on a promise to cover the lion’s share of expansion costs in perpetuity. The bill would also require a waiver from the federal government to change Medicaid rules.
“It’s a conversation,” said Sen. Ralph Hise, R-Mitchell, Berger’s deputy in the chamber and a Senate leader on health care issues.
“There are more conversations coming from the House,” Hise said, adding that this won’t be an issue settled easily or early in the session.
Making expansion part of the budget could cause that entire debate to drag on, but it won’t force any sort of shutdown if talks go past the July 1 beginning of the state’s new fiscal year.
That’s because Republicans passed legislation in 2016 that keeps the government operating at the past year’s funding levels if a budget is not in place by the start of a new fiscal year, which takes some brinksmanship off the table.
Cooper said Tuesday that state leadership must “find a way to make sure people have expanded access to health care and better quality health care.”
“I think that there are ways that we can do that and ways that we can work together to do that,” he said. “At the end of the day, I think we’re all going to have to, somewhat, agree on a budget. There will be things in there that both sides don’t like.”
Moore said he wants to find a way “to help those that are working but are having trouble paying.”
“What we don’t want to do is simply expand a, just a hand out, and be a discouragement for folks to get jobs,” he said.