Don’t call it Medicaid expansion: House Republicans offer low-income health plan

April 10, 2019

Some House Republicans are again pitching their idea to expand health coverage to hundreds of thousands of uninsured people in North Carolina, but it likely faces an uphill battle in the legislature.

The sponsors of House Bill 655, dubbed the North Carolina Health Care for Working Families Act, don’t call their proposal Medicaid expansion, noting that it would function as a private insurance plan managed by Medicaid providers.

“We think this is an alternative to close the coverage gap,” said sponsor Rep. Donny Lambeth, R-Forsyth, a former hospital administrator.

The program would emphasize preventive and wellness care and would include a work requirement for those able to work. Enrollees would have to pay a premium of about 2 percent of their income, as well as co-pays for services.

Eligibility would be restricted to people making no more than 133 percent of the federal poverty level, or about $33,400 for a family of four.

Still, backers said that would cover about 283,000 people in North Carolina, and they predicted that another 195,000 would shift onto the plan from other insurance.

Rep. Greg Murphy, R-Pitt, said he routinely sees people as a physician who put off seeking care as long as possible because they lack health coverage.

“Cancer doesn’t care if you have an insurance card or not,” Murphy said.

The proposal also includes a grant fund so rural hospitals, which struggle with large numbers of uninsured patients, could get money needed to recruit or retain physicians or expand telemedicine or other services.

“I’ve had three hospitals in this long session show up in my office wanted to know if we, as legislators, can help them subsidize their hospitals. Their hospitals are just not going to make it,” Lambeth said. “There’s hospital right now on the brink of bankruptcy, and that story is going to continue to unfold in North Carolina unless we do something proactively to help.”

The program would cost $4.7 billion a year, but the federal Medicaid program would cover 90 percent of the cost. The rest would be paid for by provider fees, insurer taxes and premiums and co-pays. Lambeth said there would be no added cost to state taxpayers, adding that the state is basically paying for such services in other states already.

“We are funding in North Carolina this amount of money today that’s going to Washington and then redistributed across other states, and we ought to take advantage of that money to benefit our citizens,” he said.

The state’s hospitals quickly jumped on board the proposal.

“For too long, North Carolinians have supported other states’ coverage expansion efforts,” Steve Lawler, president of the North Carolina Healthcare Association, said in a statement. “It is time to put that investment to work for our neighbors, supporting them in taking control of their health and wellness. We support a bipartisan approach to getting this done.”

But Democrats are holding out for a traditional Medicaid expansion that doesn’t include work requirements or co-pays.

“The quickest and simplest way to close the health care coverage gap for 500,000 North Carolinians is through Medicaid expansion,” House Minority Leader Darren Jackson said in a statement. “We have delayed for years now. These delays have cost North Carolina countless lives and billions of dollars.”

Jackson, D-Wake, noted that Democratic-based expansion proposals die every session because the Republican majority refuses to even allow a committee hearing on them.

Senate Republicans also have signaled they’re not in favor of the new House plan, and Lambeth conceded he’s got some work to do to drum up support in his own House caucus – a similar bill failed last session.

Medicaid expansion also is a priority for Gov. Roy Cooper, but he has said he would be willing to consider work requirements as part of the proposal.