For the past decade, North Carolina Senator Phil Berger has been the state’s biggest opponent of Medicaid expansion. But now, he’s definitely the main reason the expansion is only a few months old.
A multi-billion dollar recovery would see the federal government cover nearly all costs and provide health insurance for the state’s hundreds of thousands of working poor.
They plan to tie the expansion into the state budget, which is expected to become law this summer or fall. If all goes according to plan, about 600,000 North Carolinians will finally have health insurance by the end of this year.
The reaction from all corners of the state was immediate.
“It’s going to be a real game-changer for communities, especially in the state’s 80 rural counties,” Dr. Roxy Wells, hospital director in Hawke County, a suburb of Fayetteville, said in an interview Thursday. “…we want to give our community extra care and this helps us even more.”
Wells was also former president of the Board of Trustees of the North Carolina Health Care Association, the state’s largest hospital lobbying group, and had lobbied for Medicaid expansion. Rural hospitals have struggled in recent years, in part because many people in rural North Carolina lack health insurance. She said the expansion of Medicaid makes things better from the moment it becomes law.
“I’m going to get shot in the arm soon,” said Wells.
Democratic lawmakers have long been likely to back any deal to expand Medicaid. Democratic Gov. Roy Cooper and other party leaders have been calling for this moment for years.
But what has changed for the Republican Party? Many.
Nationwide, conservative political backlash against Obamacare has subsided.
Locally, many local leaders in politics, health care, and law enforcement have also changed their minds and started pushing for Medicaid expansion.
And the federal government will provide North Carolina with an additional $1.8 billion, and billions more will flow into local hospitals once the expansion is complete.
Hospitals and insurance companies have agreed to cover 10% of costs not covered by the federal government. This will ultimately cost the state government nothing.
In addition to Berger, these details helped unnerve many other Republicans.
Winston-Salem Republican Rep. Donny Lambeth, who drafted the Medicaid Expansion Bill, said, “Few people really understand how this bill works. They’re also former hospital executives.” and new costs to taxpayers, but that is not true.
Even with the participation of top leaders, other Republicans are skeptical.
Republican Division
When the state legislature passed its own preferred version of the expansion bill earlier this year, the final vote was 96 to 23. Ultimately, about a third of Republican lawmakers voted against it.
Raleigh’s conservative think tank, the John Locke Foundation, opposes the expansion. So does the group Americans for Prosperity, a project of the libertarian Koch Brothers.
“The study found little benefit in other states that expanded Medicaid, but increased wait times for health services, significantly increased budgets, and made no difference in health care outcomes.” The North Carolina Chapter of Prosperity Americans said in a statement Thursday.
That’s just plain wrong, says the state’s top medical official. When more people have health insurance, not only will their health improve, but so will their economies, said Cody Kinsley, state secretary of health and human services.
“Here in rural North Carolina, more than a dozen hospitals have closed in the last decade,” Kinsley said in an interview about WRAL’s On the Record program. “In states that have expanded Medicaid, rural hospitals are consistently able to function and continue to operate.”
The Census data also shows why, from a political standpoint, Republicans want expansion. In more liberal areas of the city, relatively few people tend to be uninsured. But in more rural and conservative parts of the state, one in five of her adults is uninsured. This is especially true in the western mountains and southeastern Sandhills.
Republican Senator Kevin Corbyn, who represents rural North Carolina west of Asheville, believes the expansion of Medicaid is a financially conservative decision, even if some conservative groups disagree. I’m here. He said it would cut costs for local hospitals, local governments and those with insurance.
“People who have insurance pay an estimated 10% more for their insurance,” Corbyn said in an interview.
how it will unfold
Uninsured people are not prohibited from receiving medical care. They usually receive it in a hospital emergency room or, due to a growing number of cases related to mental health and substance abuse issues, are placed behind bars in county jails.
Lawmakers like Corbyn say treating people in emergency rooms and prisons is far more expensive than options open to people with insurance. You can get help from your insurance by making an appointment with and paying for the medicine.
Steve Lawler, chief executive of the State Medical Association, says giving hundreds of thousands of people a chance to get treatment before it becomes an emergency will only lead to better outcomes. The domino effect could include lower costs and shorter hospital wait times, he said.
“These individuals will have the opportunity to receive care in another setting, rather than in the most expensive setting, which is the emergency department,” Lawler said. We really need to free up hospital capacity to do that.”
One factor complicating the hospital Lawler represents is the controversial policy change that comes with the expansion of new Medicaid contracts. This is a partial repeal of the required certifications law intended to protect hospitals from facing undue competition.
Opponents argue that these laws violate free market principles and allow health care providers to charge high costs.
The main critic is Senator Ralph Hise, a Mitchell County Republican who co-chaired the Senate Health Committee and has been trying for years to repeal these Certificate of Necessity (CON) laws. He was one of the few lawmakers in the room when the Medicaid expansion contract was being drafted.
“I’ve been here for 13 years, and 13 years ago, before I joined the medical board, I was trying to do this,” Hise said in an interview. “So we are happy to finally conclude. We are excited to finally make some changes to the CON regulations.”
But proponents say the CON protection actually keeps costs down for people by allowing hospitals to avoid a costly arms race with each other for new facilities and equipment.
Lawler’s group, the Healthcare Association, is one of the biggest supporters of the CON Act. A spokeswoman for the group said it’s impossible to know exactly what the impact will be because details haven’t been made public yet.
Ultimately, though, it pales in comparison to the billions of dollars the expansion of Medicaid is expected to bring in each year.
Speaking “on the record,” Lawler said the expansion was welcome news, especially after a tough period of the COVID-19 pandemic.
“The last three years for North Carolina hospitals have been probably the most difficult times in North Carolina history,” he said. “We have led the state through the pandemic. We have dealt with unprecedented economic pressures. We are grateful for this measure.”
WRAL State Government Reporter Travis Fain contributed to this report.
