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

Pool photo file

RALEIGH — 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, held on Dec. 4, 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.

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.”