Attempts to remove the work and household monthly premium requirements from a proposed Medicaid expansion bill failed to win approval in the House Health committee Wednesday.

The committee addressed 12 amendments to House Bill 655, four of which were approved. Those include removing language that would have delayed the potential rollout by six months from July 1, 2020, to Jan. 1, 2021.

Five amendments were withdrawn after Rep. Donny Lambeth, the primary sponsor of HB655, said he would discuss the potential legislation with their sponsors.

Lambeth said following the committee meeting that “the thought is give me some time to work on a few of the amendments withdrawn.”

The revised bill was recommended back to the House Rules and Operations committee. It is not clear when the full House will address the bill.

“We plan a week or so break,” Lambeth said. “It could be back on the floor first week we are back, but would be Day 2 or 3.”

The bipartisan bill has proven controversial because it 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.

Those requirements have been held up by federal judges in at least three states.

Many of the 12 amendments were submitted on the House floor after HB655 was fast-tracked by House Republican leadership July 9 as a negotiating tactic linked to Democratic Gov. Roy Cooper’s June 28 veto of the GOP state budget compromise.

HB655 subsequently sat unaddressed for 36 consecutive House floor sessions before being removed by House speaker Tim Moore on Sept. 11 at Lambeth’s request.

The bill was sent back to committee shortly after the House GOP leadership conducted its highly controversial veto override vote with most Democratic members absent from the chamber. Moore has pledged to hold a vote on HB655 once it returns to the House floor.

Lambeth said his goal was “to do committee work in the committee, not on the floor.”

Lambeth said the decision to revert to the original July 1, 2020, rollout was done at the request of state Health Secretary Dr. Mandy Cohen. The delay language was added to HB655 on Tuesday.

Work requirement too onerous?

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.

Removing the work and 2% household monthly premium requirements was opposed by Lambeth. He said both changes would “change the fundamentals of the bill” too much to retain what House Republican support there is for limited Medicaid expansion.

Amendment sponsors said the requirements don’t reflect the economic realities of individuals living below the poverty line in terms of finding work and siphoning income need to pay for bills, groceries and health care.

“This bill has a chance to clear the House only if Democrats reconcile themselves to the necessity of work requirements and premiums,” said Mitch Kokai, senior policy analyst with the Libertarian think tank John Locke Foundation.

“If Democrats hold out for Gov. Cooper’s version of Medicaid expansion with no skin in the game for new participants, the bill will fail.

“Even if Democrats sign on to these necessary provisions, it’s not clear that enough House Republicans will join them to secure a majority.”

Besides Lambeth’s rollout deadline amendment, three others were approved by the committee.

They addressed:

  • Allowing up to 120 days, rather than 90, before an individual loses Medicaid coverage for non-payment of the monthly premium;
  • Adding language addressing health disparities; and
  • Changing the wording from “substantially” to “materially” how much the federal Centers for Medicare and Medicaid Services can alter the state’s Medicaid waiver request before the legislature and N.C. Department of Health and Human Services ends the expansion initiative.

Among the withdrawn amendments included: adding unpaid, volunteer and community-engagement opportunities to count toward the work requirements; as well as creating exemptions for veterans, homeless, victims of domestic violence, individuals affected by natural disasters, released from jail or prison within the past 12 months, and certain students.

90% funding pledge

The latest version of HB655 definitively declares that the initiative would end if the federal government doesn’t keep its 90% funding pledge. The bill adds immunizations to the list of preventive care and wellness activities covered by the expansion.

The tweaking severs the bill from the state budget compromise. The previous version of HB655 said its implementation is contingent on the state budget becoming law first.

HB655 has the potential to expanding Medicaid coverage in the state. Several studies have estimated that between 450,000 and 650,000 North Carolinians could be covered.

Senate Republican leadership, foremost Senate leader Phil Berger, R-Rockingham, oppose HB655, in large part because of its dependence on federal funding and its reliance on an annual $758 million assessment from the state’s hospitals and healthcare systems.

Cooper vetoed the state budget compromise, Berger has claimed that 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.

Medicaid expansion supporters say a significant number of potential beneficiaries are individuals and families who fall in the current coverage gap of making too much in household income to qualify now for Medicaid, but not enough to afford coverage on the federal health exchange.

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% federal government match is sustainable and would take an act of Congress to change.

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