Governor’s new health care group has tough time getting past Medicaid barrier

Gov. Roy Cooper is still selling Medicaid expansion, but Republican lawmakers still aren’t buying. 

The first meeting of the bipartisan N.C. Council for Health Care Coverage fractured into a partisan divide over expanding Medicaid. Cooper spent hours pushing for Medicaid expansion, but Republican lawmakers declared themselves disappointed in his focus. 

Cooper formed the N.C. Council for Health Care Coverage to find solutions for the 17% of adults who are uninsured in North Carolina. The council includes 48 members — including lawmakers, physicians, pastors, and businessmen — but Republican lawmakers questioned the absence of the John Locke Foundation during the meeting Friday, Dec. 4.

Little appears to have changed since Medicaid expansion sank last year’s budget, and it seems likely the issue will haunt the new session in January 2021. 

“To be honest, I was a little disappointed to see that we’re starting with Medicaid expansion, because it has been such a controversial topic,” Sen. Joyce Krawiec, R-Forsyth, said. “So I am glad that we’re moving on to other things. We know that in order to increase access, we need to find ways to reduce costs.” 

Cooper wants to expand Medicaid to cover 626,000 people who make less than 138% of the federal poverty level. The federal government picks up 90% of the cost of what Cooper says would be a $4.3 billion price tag in 2021. 

Cooper proposed putting the remaining 10% on hospitals and providers. Whether they are still willing to accept that burden is unclear. Members noted that other states that used a provider tax to pay for expansion also then raised providers’ reimbursement rates. 

“Health care providers have taken a pretty big hit from COVID,” said Gene Woods, president of Atrium Health. “That’s going to be important to make sure we’re not disrupting access in a different way by mismatching those resources.”

Cooper hasn’t softened his focus on expansion. For two hours, every presentation touted the purported benefits of Medicaid expansion, including covering the working poor, saving rural hospitals, and combating the opioid epidemic. 

But Republicans remained unmoved. They changed the conversation once the meeting opened for questions. They argued for ways of reducing the cost of health care, rather than solely focusing on increasing the coverage of those costs. 

Krawiec suggested expanding access to telemedicine, and reforming scope of practice and licensure laws to allow providers to practice up to their full abilities. She wants to reform the Certificate of Need laws that choke competition within the state by restricting the supply of medical equipment. 

And she focused on moving ahead with Association Health Plans, which would offer businesses the chance to bargain for health insurance as a larger group. The law allowing the plans is currently tied up in court. 

“It’s just prohibiting a lot of people from getting the coverage they can get,” Krawiec said. “The business community was overwhelming behind it. It’s a great idea to provide coverage for people, especially in low wage industries.”

Krawiec pointed to policies advocated by the John Locke Foundation.

“I was a little bit disappointed that we didn’t include one of the most well-known policy health think tanks in North Carolina, the Locke Foundation. Maybe that was just an oversight,” Krawiec said.

Department of Health and Human Services Secretary Mandy Cohen said she may invite JLF representatives to the next meeting. The foundation recently published a report warning that Medicaid expansion could create a funding gap of $119.3 million to $171.3 million in the first year. The report criticized Cooper’s math. 

“I know they have a number of ideas, and we really need that marketplace of ideas on coverage,” Cohen said. 

JLF Senior Political Analyst Mitch Kokai said the foundation appreciated the acknowledgment.

“The John Locke Foundation has been advocating market-based reforms that address the state’s real health care concerns for most of the organization’s three-decade history,” Kokai said. “A comprehensive discussion of health care policy ought to include ideas from across the political spectrum. We look forward to helping state leaders find the most efficient, effective ways to boost health care access for all North Carolinians.”