Health policy at General Assembly: 2019 in review
It was a tumultuous year for lawmakers in the General Assembly. Lasting well into October, this ‘long session’ was unusually long compared to years past. As will be the case in the 2020 election cycle, health care dominated the issues discussed during policymaking in this session. Many bills related to health care were introduced. While some stalled, some passed the legislature and were signed into law. I will use this space to review some of the health care ideas lawmakers debated in 2019.
Medicaid dominated the health care debate in the General Assembly on two fronts: expansion and transformation. Medicaid expansion was a question of whether to expand our state’s Medicaid program to include able-bodied, working-age adults in the program traditionally for low-income mothers and seniors, children, the blind, and the disabled. Wisely so, lawmakers rejected this massive expansion of public health insurance. Medicaid expansion would put our state budget and current Medicaid population at risk, is unlikely to provide an economic boon, and does nothing to address core problems plaguing the health care system.
Medicaid transformation is a separate issue from Medicaid expansion. Transformation describes the transition of North Carolina’s Medicaid program from a fee-for-service model to a managed care model. This transition was years in the making as the Department of Health and Human Services was directed to make this change by the General Assembly in 2015. Under a managed care model, managed care companies would compete for enrollees, and be paid a per-member, per-month rate to care for all covered lives in their plan. Transformation’s intended rollout date was November 2019 for some enrollees. Following Gov. Roy Cooper’s veto of the budget, this date was moved back to February 2020 because of a lack of funding. Cooper then vetoed a separate stand-alone funding bill, indefinitely delaying the rollout of Medicaid transformation. It remains unknown when transformation will finally be completed.
The most impactful piece of health care legislation passed by the General Assembly was the association health plan bill. AHPs allow groups of individuals or small businesses to band together to purchase a large group insurance plan through a business or trade association. Previously, this population’s only choice was to buy what was offered on the Obamacare exchanges or to go without insurance. AHPs give small businesses and individuals an additional, more affordable avenue to acquire health insurance. Despite bipartisan support of the bill, Cooper refused to sign it, and after 10 days of sitting on his desk, the bill became law.
Another piece of health policy signed into law was the Rural Health Care Stabilization Act. Introduced by Sen. Leader Phil Berger, R-Rockingham, language from this bill was rolled into a larger bill and eventually passed both houses and was signed by the governor. This provision would allow rural hospitals in a financial crisis to apply for a loan from the state government. The law details the protocol for application and repayments of the loan.
While there was some great work done at the General Assembly to fight Medicaid expansion and get the AHP bill signed into law, the work is far from over to help North Carolinians get more affordable and easier access to health care. Several bills were introduced to deal with important health care policy issues, only to die in committee or on the floor. Among those were bills to amend the state’s certificate of need laws and to reorganize how nurse practitioners and other advanced practice registered nurses are regulated. Further, there are areas ripe for reform, such as telehealth and dental therapy, which should be addressed next session.
Health care isn’t going away as the top issue for most voters. I hope lawmakers continue to build on the work they did this session by implementing more market-oriented reforms in the health care sector. North Carolinians are denied a level of affordability and access to health care because of invasive government regulation of the health care industry. We must address these supply-side issues at the state level if we want to seriously make progress on lowering the cost of care and on increasing access for residents.
Jordan Roberts is health care policy analyst for the John Locke Foundation.