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The state Capitol in Raleigh

A state House Democrat has submitted a Medicaid expansion bill that he says addresses Senate Republican opposition to the legislation.

House Bill 1032 was introduced by Rep. Billy Richardson, D-Cumberland, during Tuesday’s brief extension of the 2019 legislative session. Co-sponsors include Rep. Cecil Brockman, D-Guilford.

The bill carries forward to the 2020 session set to begin April 28. It represents a compromise from other Medicaid expansion bills, including House Bill 655 submitted by Rep. Donny Lambeth, R-Forsyth.

The bill would not require a 90% federal match for additional administrative costs for expansion.

As such, it could reduce the number of potentially eligible North Carolinians to 250,000 from an often-cited range of 450,000 to 650,000 with the federal funding match.

Democratic Gov. Roy Cooper vetoed the GOP budget compromise June 28, citing primarily the lack of Medicaid expansion and the GOP offer of a 3.9% raise for public school teachers compared with his recommendation of an 8.5% to 9.1% increase.

Senate Majority leader Phil Berger, R-Rockingham, and other Senate GOP leadership have stated their concern that the federal government under the Trump administration could opt to end its match even though it is providing funds for the 36 expansion states.

Berger told reporters Tuesday “there are not the votes to pass Medicaid expansion (in the Senate). That’s not an ultimatum, but a factual statement that it would not pass.”

Lambeth has said the 90% federal government match is sustainable and would take an act of Congress to change. He said HB655 requires North Carolina to halt the expansion if federal funding is pulled.

On Tuesday, he told online legislative media outlet The Insider the bill was in response to Berger’s concerns about federal funding.

“Both sides have got to start offering compromise, and we need to think outside the box,” Richardson said. “There’s too much good in that budget not to compromise. It’s shameful on both sides.”

Richardson told the Winston-Salem Journal on Thursday that Lambeth told him he "appreciates the effort to try and do something to help our citizens, medical providers and hospitals."

"My oldest son reminded me that North Carolina has resources larger than most countries, and why not take care of our own?

"So, in the spirit of compromise and in an effort to insure an additional 250,000 hard-working citizens, I offered this alternative which is not relying on Sen. Berger’s deepest and sincere concerns," Richardson said.

Lambeth said Thursday that "I don't believe this is a partisan issue. It is an issue of fairness and improving healthcare to people and families who need help."

Brockman said Wednesday the bill is a step toward expanding Medicaid eligibility.

“Obviously, with session adjourned until April and the Senate Republicans’ complete refusal to consider helping citizens in need of health care, it is unlikely that this bill will be considered.

“Still, I think it is important to show our commitment toward Medicaid expansion and bringing health care to North Carolinians.”

Lambeth said he is not optimistic about HB1032 gaining Senate GOP support.

“It has no chance” Lambeth said. “Unfortunately, some seem to have made up their minds based on erroneous information and seem unwilling to look at any option that has Medicaid and expansion in the same phrase or sentence.”

Fewer eligible for expansion

Medicaid currently covers 2.2 million North Carolinians.

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.

At that eligibility level, several studies, as well as Medicaid expansion advocates, have projected an increase of 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%.

By comparison, HB1032 would include only households with incomes below 100% of the poverty line, or $25,750 for a family of four.

Richardson proposes $500 million in annual expansion monies from the General Fund, as well as a tax on pharmaceuticals sold in the state.

HB1032 would retain an annual $758 million assessment that the state’s hospitals and health-care systems have agreed to provide, as well as a tax on prepaid health plan premiums and an assessment on managed care organizations.

HB655 has a work or community volunteer requirement of up to 80 hours per month for some recipients, as well as a monthly Medicaid coverage premium based on 2% of household income.

The work requirements have been held up by federal judges in at least Arkansas, Kentucky and New Hampshire. CMS is appealing the rulings in Arkansas and Kentucky.

“A partial Medicaid expansion of this sort ... would have likely proved attractive to some legislative Republicans,” said John Dinan, a political science professor at Wake Forest University and a national expert on state legislatures. “When Utah tried to do a partial expansion of this sort last summer, (Centers for Medicare and Medicaid Services) officials ruled that this was not allowed, and said that states had to do a full expansion to qualify for the 90% federal reimbursement rate.

“Otherwise, states only get reimbursed at the regular reimbursement rate, which in North Carolina’s case is around 67%.

“I have not seen any indication of any states signing on to partial expansion after the CMS ruling last summer,” Dinan said.

Budget veto remains intact

Berger and Senate Republican leaders placed on Tuesday’s floor agenda a potential vote to override Cooper’s budget veto.

However, they withdrew the bill after a vote failed to override Cooper’s veto of a mini-budget bill focused on public school teacher raises.

“The N.C. Republican strategy to override or bust was on full display during what should have been a special session on health care,” said William Munn, policy analyst for the left-leaning N.C. Justice Center’s health advocacy project.

Mitch Kokai, senior policy analyst with Libertarian think tank John Locke Foundation, said HB1032 “has no chance of moving forward under current conditions.”

“While Rep. Richardson appears to have a sincere interest in putting forward a compromise proposal, it’s not clear that any of the key players in the Medicaid expansion debate want to compromise on the issue.”

Kokai said the bill “would not address Republican lawmakers’ concerns about long-term funding or about crowding out services for Medicaid’s traditional population of the most disadvantaged North Carolinians.”

The GOP state budget bill would increase the number of intellectual/developmental disabilities (I/DD) Medicaid innovation waiver slots by up to 1,000 at a cost of $32 million over two years. Services include personal care and in-home assistance.

Senate GOP leaders focused during the 2019 session on reducing the I/DD list in an attempt to counter building momentum for expanding Medicaid.

Within the overall I/DD wait list of more than 12,000 individuals are hundreds who have been on it for more than 10 years, including throughout GOP control of the legislature that began in 2011. The list also is known as the registry of unmet needs.

About 400 individuals were removed from the list in 2018.

“North Carolina taxpayers are already paying for other states to expand Medicaid, and HB1032 would come at a higher cost as it relies on state entities and our state general fund and cover fewer people,” Munn said.

A report released in June by the Kate B. Reynolds Charitable Trust and the Cone Health Foundation determined that expanding Medicaid would create more than 37,000 jobs, including 20,600 in the health-care sector, by the end of 2022, as well as bring in an additional $11.7 billion in federal Medicaid funding from 2020 to 2022.

“Senator Berger and Speaker Moore’s refusal to offer or hear any solutions to increase health care for our working families who are forced to choose between going to the doctor and putting food on the table,” Munn said.

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