A compromise reached in conservative-leaning Kansas to expand Medicaid is not likely to influence lawmakers in North Carolina, Senate Majority leader Phil Berger said Tuesday.
Medicaid currently covers 2.2 million North Carolinians, with projections of expansion adding between 450,000 and 650,000 residents. At 2.65 million participants, that would represent 25% of the state’s population, while at 2.85 million, it would represent 26.8%.
Berger, R-Rockingham, was asked by reporters for reaction to a first-term Democratic governor and the Republican Senate majority leader in Kansas achieving an agreement that would allow it to become the 38th state — and 15th red — to expand its Medicaid program.
Berger said he did not believe Kansas would have any effect on Senate Republicans’ opposition to expanding Medicaid in North Carolina.
“My Republican colleagues have not raised Medicaid expansion to me,” saying the only groups that have since the Kansas agreement became public are media outlets.
“There are not the votes to pass Medicaid expansion (in the Senate),” Berger said. “That’s not an ultimatum, but a factual statement that it would not pass.”
The Affordable Care Act makes Medicaid available to households with incomes below 138% of the poverty line, or nearly $36,000 for a family of four.
The agreement is the third of its kind recently between a Democratic governor and Republican-controlled legislature. The others are Kentucky and Louisiana. Those bipartisan successes have raised the question of why a compromise can’t be reached in a similar scenario in North Carolina.
Berger said Senate Democrats are supporting Gov. Roy Cooper’s veto of a state budget without a form of Medicaid expansion for political reasons.
“They are holding out in 2020 because they believe they will be in charge (of the legislature) in 2021, and that’s not going to happen,” Berger said.
Rep. Donny Lambeth, R-Forsyth, has expressed confidence that his Medicaid legislation, House Bill 655, has bipartisan support even with having a controversial work requirement that has been put on hold in four red states by a federal judge.
Berger acknowledged he has made passing glances at HB655, which has been stalled in the House Rules and Operations committee since September after Lambeth agreed to make a few changes and consider others requested by Democrats.
“I haven’t read the bill since it has not arrived in the Senate,” Berger said. “When it does, then we will consider whether to take it up.”
Berger’s opposition carries more weight than similar Medicaid expansion scenarios in Idaho, Missouri, Nebraska and Utah because unlike those states, North Carolina citizens do not have the ability to initiate statewide ballot referendums.
Berger and other Senate Republican leadership have been adamant opponents to expansion since it surfaced in 2012 as an option through the Affordable Care Act.
The bipartisan HB655 contains two elements key to expansion in Republican states: a work or community volunteer requirement for some recipients; and a requirement that recipients pay 2% of their monthly household income for Medicaid coverage.
Mitch Kokai, senior policy analyst for Libertarian think tank John Locke Foundation, said “the work requirements included in the Kansas package might appeal to those — especially in the N.C. House — who supported similar proposals here.”
However, he cautioned that “Senate leaders who have been uninterested in any version of Medicaid expansion are unlikely to change their minds, regardless of what happens in Kansas.”
The agreement in Kansas “makes the (seven) Southern block of states look more and more like stubborn outliers in refusing to even consider more conservative versions of Medicaid expansion,” said Mark Hall, a law and public-health professor at Wake Forest University.
Those Republican-leaning states are Alabama, Florida, Georgia, Mississippi, North Carolina, South Carolina and Tennessee.
Most left-leaning advocate groups say that while they support Medicaid expansion, the work and premium requirements are too onerous overall compared with the potential benefit.
Berger and Republican leadership have stated their concern that the federal government may opt to end its 90% match on additional administrative costs for expansion. They also oppose an annual $758 million assessment that the state’s hospitals and health-care systems have agreed to provide.
Berger claims Cooper is “holding the entire budget hostage” over Medicaid expansion that he says puts “able-bodied individuals” in front of disabled individuals for funding priorities.
However, several public-health advocates, as well as Lambeth, have said the GOP warning is unfounded.
For the 36 Medicaid expansion states and the District of Columbia, the federal government has been consistent even under the Trump administration in meeting its 90% contribution.
Lambeth told a House committee in July that the 90% match is sustainable and would take an act of Congress to change.