Senate Leader Phil Berger on Monday took aim at provisions in Rep. Donny Lambeth’s bill to expand Medicaid in the state, saying it represents a tax that ultimately will be passed on to patients.

The bill first was introduced in April 2017 but stalled in committee. Lambeth, a Republican from Winston-Salem, has said he plans to re-introduced the bill this session. He could not be immediately reached for comment Monday.

Both Lambeth’s bill and Democratic-sponsored 2019 expansion bills (House Bill 5 and companion Senate Bill 3) would require health-care systems and hospitals to pay for the state’s 10 percent share of expanded service and administrative costs. The federal government would pick up the remaining 90 percent.

The N.C. Medical Society and N.C. Healthcare Association have signaled their support for the assessment as part of potentially caring for an additional 470,000 to 650,000 Medicaid beneficiaries.

Lambeth’s bill also includes a controversial work requirement in an attempt to gain bipartisan support.

Berger said he considers the assessment to healthcare systems as a tax.

“Governor Cooper is pushing this idea that his Medicaid expansion proposal is revenue-neutral to the state, but that idea is just not based in reality,” Berger said. “There is no such thing as free money; someone always has to pay.

“In this case, it’s the taxpayers in the private insurance market who at the end of the day will pay the price of this new tax to fund expansion.”

Jamal Little, spokesman for Democratic Gov. Roy Cooper, said “hospitals and other healthcare providers are for Medicaid expansion because it increases their bottom line and helps get more patients insured.”

‘Should be a wash’

Berger also repeated his concern — expressed since the Affordable Care Act, or Obamacare, made Medicaid expansion possible — that the federal government could opt to not continue to pay its share even though analysts say that is an unlikely scenario even under the Trump administration.

Mark Hall, law and public-health professor at Wake Forest University, is an expert in legislative issues. In April, he released a study titled “Do States Regret Expanding Medicaid?”

Hall said requiring hospitals to help pay for North Carolina’s 10 percent of new administrative costs “is not likely to increase costs to patients because hospitals will also see reduced uncompensated care. The two effects — tax and reduced uncompensated care — should be a wash.”

State Rep. Darren Jackson, D-Wake, has said the bill should gain support because “it is revenue neutral.”

Mitch Kokai, policy analyst with Libertarian think tank John Locke Foundation, said the senators “are correct to consider this new charge as a tax.”

Disputed assertions

In a Feb. 20 statement, Berger said Democratic claims of the value in Medicaid expansion “are simply misleading at best and purposely deceptive in some instances.”

Several advocates and analysts have disputed Berger’s assessment about the Democrats’ push.

“It’s time to stop the partisan scare tactics and start telling the truth,” Little said.

Berger’s latest statement came after Cooper highlighted — as expected — expanding Medicaid in his 2019-20 state budget recommendation last week.

The state Medicaid program currently serves 2.1 million residents, 1.6 million of whom will be affected by the Medicaid waiver reform being rolled out between now and early 2020 by the N.C. Department of Health and Human Services.

“Gov. Cooper’s budget plan recommends expanding Medicaid to bring $4 billion into North Carolina’s economy, create an estimated 40,000 jobs and provide more affordable health care for 500,000 people,” according to a statement from Cooper’s office.

Hall said there is “no objective reason to think that the federal government will reduce its 90 percent support.”

“If it were to do so, then N.C. could simply redesign its eligibility criteria in response to the reduction,” he said.

John Dinan, political science professor at Wake Forest University who focuses on legislative issues, said Berger’s statements makes it even clearer that “any effort to get legislative approval to sign on to the Affordable Care Act’s Medicaid expansion this year is going to be the product of very difficult (state budget) negotiations and bargaining.”

Berger and Senate Deputy Pro Tem Ralph Hise, R-Mitchell, repeated bullet points that apparently are shaped by the right-leaning Foundation for Government Accountability.

“Expanding Medicaid would cost our state billions of dollars in the long run and would prevent us from funding other important needs, like North Carolina’s Intellectual/Developmental Disability Medicaid program, which provides critical care to disabled North Carolinians and currently has approximately 12,000 people on the waiting list,” Hise said.

The I/DD program allows people with intellectual disabilities to receive services and assistance in their homes and communities instead of an institution. The services involve in-home skill building, intensive recovery supports and transitional living.

The waiting list has had hundreds of individuals on it for more than 10 years, throughout Republican control of the legislature that began in 2011. The list also is known as the registry of unmet needs.

Rep. Verla Insko, D-Orange, a leading legislative healthcare expert, said about 400 individuals from the list were provided additional services in the last state budgets at a cost of $2.58 million in 2017-18 and $5.1 million in 2018-19.

“We still have as many on the waiting list as are currently being served,” Insko said. “We need to add slots in every budget until we get closer to filling the need.”

Rob Schofield, policy analyst with left-leaning N.C. Justice Center, said “it’s hard to know whether to laugh or cry at Berger’s protestations about the supposed immorality of expansion, especially when he already possesses the power to end any existing waiting lists that might exist for the program.”

Kokai said the I/DD example from Hise “is designed to make a point.”

“Most of the beneficiaries of expansion would be able-bodied, working-age adults,” he said. “Add more people in that category to Medicaid, and they inevitably will compete for program dollars that could otherwise help children, the disabled and older residents.”

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