Politics & Government

GOP’s Medicaid expansion compromise is back on the table after surprise budget vote

The topic at the heart of the summerlong state budget standoff — Medicaid expansion — is getting renewed attention after state House Republicans surprised Democrats with a budget vote while most of them were absent.

NC Health Care for Working Families, House Bill 655, was added to the House floor calendar on July 9, at the same time as the budget override veto. The issues were tied together: Gov. Roy Cooper vetoed the budget primarily because it did not expand Medicaid as the Obama-era Affordable Care Act allows and as 36 states and the District of Columbia have decided to do. House Republicans offered a bill that they said would be considered along with the override, as a way to address Medicaid expansion without passing the full expansion that Cooper and Democrats want.

The key differences between Medicaid expansion that Democrats want and the compromise some Republicans are offering is a work requirement and monthly premium.

The premium would be 2% of a person’s annual income and paid out every month. Participants would be eligible if their income did not exceed 133% of the poverty level, are between 19 and 64 years old, are not already covered by Medicare, are ineligible for the existing Medicaid program in North Carolina, and meet federal citizenship and immigration requirements. The bill would also establish a grant program for rural access to health care.

But the bill still has a ways to go, explained Rep. Donny Lambeth, the bill’s primary sponsor and a Forsyth County Republican.

Timeline for Medicaid expansion bill

“There’s a lot of work still to be done. If you look at the bill, it’s probably one of the shortest, simplest bills for a complex topic, and that leaves a lot of the administrative work yet to be done [by the Department of Health and Human Services],” Lambeth told reporters on Wednesday after a meeting of the House Health Committee.

After the budget override vote on Sept. 11, Health Care for Working Families was sent back to committee to work out questions and the amendments that had been added. The committee worked through some of the proposed amendments Wednesday — including those from Democrats that would drop the work requirement, which failed.

After a stop in another committee, the bill is expected to go on to the House floor, but it could be at least another two weeks before it is discussed there.

The House is taking a break the rest of this week and next week, returning on Sept. 30. Lambeth said he’ll need a few days after that to work on some of the details brought up in committee before it’s ready for floor discussion.

Lambeth acknowledged it would be a close vote in the House to pass it.

Objections to HB 655

Democrats want the work requirement and premiums dropped. And some Republicans don’t like the idea of any kind of Medicaid expansion, saying it adds to the federal deficit and raising the possibility that the federal government won’t always pay the bulk of the costs as it does now.

Rep. Becky Carney, a Mecklenburg County Democrat, said the work requirement would add bureaucratic red tape and administrative costs.

“Frankly, is this a good use of our taxpayer money?” she asked in the meeting Wednesday. She said that those eligible for full Medicaid expansion may already have been working multiple jobs and the added paperwork would be a burden.

Carney said she liked the bill, but wanted some things fixed before voting for it.

Getting support from conservatives

A conservative group is trying to gain Republican support for the bill.

The NC Fund for a Conservative Future began running radio ads in August in support. Lambeth said he’s talked about the issue to civic groups and others, trying to explain it.

Some conservatives have told him they don’t like it because they think it’s expansion, Lambeth said. So he tells them about the work requirement, that there’s no state funding and it includes preventative care.

“Then people become, ‘Oh that’s a good thing,’” he said.

Lambeth is sticking to the work requirement, which can also be volunteer work, and the premiums. Work requirements have been knocked down by the courts in some states.

“People tell me they want to pay something, they just can’t afford to pay $600 or $700 a month for health insurance, and that’s the option they have with their employers. My own daughter actually pays more for health insurance than she does for her family’s mortgage, a middle class family,” he said.

What’s next

Even if it passes the House, it still has to make it through the Senate.

“I had a lot of discussions with Speaker Moore about this, and basically what Speaker Moore said to me was don’t worry about the Senate, do what you believe is right for the House, and we’ll deal with the Senate when we get to that point,” Lambeth told reporters.

This summer, Senate Republicans said repeatedly that Cooper was holding the budget “hostage” over Medicaid expansion. They support what was in budget Cooper vetoed — now in the Senate’s hands after the House override — which calls for a separate legislative session on health care.

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Dawn Baumgartner Vaughan covers North Carolina state government and politics at The News & Observer. She previously covered Durham for 13 years, and has received six North Carolina Press Association awards, including a 2018 award for investigative reporting.