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Legislature could finally expand Medicaid

Legislature could finally expand Medicaid

Not long ago, it was an issue so contentious that it resulted in a three-year budget stalemate, but with Republican opposition in the General Assembly softening, Medicaid expansion has a better chance than ever to become the law of the land — if a few final hurdles can be overcome.

“Even though passing full Medicaid expansion  in past years would have helped our citizens and our rural hospitals, I would not have voted for an expansion under the circumstances as they existed then,” said Sen. Kevin Corbin (R-Macon). “We have changed things dramatically and that’s why it is a wise option for North Carolina to go ahead at this point.”

Corbin said that reforms in the way Medicaid is administered have made the system much more efficient and that private insurance companies are processing claims in a much more capable manner, similar to how Medicare advantage plans have been handled for 30 years. 

“I now have more confidence in the handling of Medicaid dollars,” said Corbin, who’s been an advocate for expansion in the past but is now all-in. 

North Carolina has been paying for Medicaid expansion for years, but the estimated 600,000 people who would benefit from expansion haven’t received any services due to the General Assembly’s hesitance to adopt it. 

When the Affordable Care Act (Obamacare) was first adopted, the federal government offered to pay 100% of the states’ expansion cost for Medicaid. That inducement dropped by a few percent each year until hitting a planned phase-down of 90% in 2020. 

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Previously, legislators cited concerns that the feds could further lower the percentage — they can’t without action from Congress — leaving states on the hook. 

The current bill addresses that with a provision that the state will withdraw from the expansion if the feds lower the percentage. 

There was also the argument that the 10% not covered by the federal government could end up as a huge expenditure for non-expansion states, however, North Carolina’s bill would pass 100% of that cost onto hospitals. 

There’s even a work requirement for those who wish to enroll in the program, satisfying conservatives who are concerned that some would see the program as yet another government handout. 

“This bill will allow North Carolina to draw down billions of dollars for North Carolina citizens that will benefit rural hospitals and providers in a great way,” Corbin said. “It will mean a lot to our economy especially in rural North Carolina, which is why I support it.”

The revamped plan, however, has still been met with resistance from some Republicans. 

“I don’t think we have fixed the access problem,” said Rep. Mark Pless (R-Haywood). “Expanding Medicaid isn’t going to do anything if we don’t have more doctors. People may have a card that says they can go get care, but right now we are at such a point that we’re not able to hold nurses, we’re not able to attract doctors, we’re not able to do anything to get people care. If you throw hundreds of thousands of people into the system, they may have a card, but it doesn’t mean they’re going to get a provider.”

There’s a fair bit of truth to that. A 2020 report released in January of 2022 by the American Association of Medical Colleges  puts North Carolina at 28th out of 50 states in active physicians per 100,000 residents, with 264. Massachusetts ranks first with 466 and Idaho places last, with 196. North Carolina ranks 33rd in in primary care physicians, and 37th in general surgeons. 

The situation isn’t much better for nurses. According to a February 2022 report produced by healthcare info website Becker’s Hospital Review , North Carolina ranks 42nd out of 50 states in the number of active RN licenses per 100 residents, with 1.41 — slightly below the national average of 1.55. Vermont leads the way with 3.3, and California ranks worst with 1.19. 

“I don’t want to support the bill. What I want to do is, I would like to see the discussion focus on how are we going to expand access and then look at it,” Pless said. “So far nobody will even talk about expanding access. I think we could do incentives. We might be able to help with student debt. We might be able to do a lot of things to get some more doctors out here, but in rural Western North Carolina, there’s no way we will ever have enough doctors without an active process to draw them out here.”

Rep. Mike Clampitt (R-Swain) said that House members hadn’t yet had a chance to caucus on the proposal, so Clampitt offered no sign of support either way. Rep. Karl Gillespie (R-Macon) didn’t return multiple calls for comment. 

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