North Carolina and Medicaid Expansion progress

Earlier this month, the North Carolina State passed, for the first time, a Medicaid Expansion bill:

Will NC Medicaid expansion ride tailwinds or lean into new headwinds? – North Carolina Health News https://t.co/IHJOwMQ3u4

— Teresa MASIA PERALES (@Spanishcountry) June 6, 2022

The governor, Roy Cooper (D-NC) has been actively pushing Medicaid Expansion since the day he was inaugurated in 2017. He has not made progress on that objective until this month.

The Republican majority State Senate passed a bill with Medicaid Expansion in it 44-2. It still has to go to the House where there is a decent chance of it passing if it is put up for a vote. That is the critical question — will the bill be put up for a vote. This is the power of negative agenda setting where the agenda setter (the House Speaker/Majority Leader) controls what gets on a calendar and what is possible in going forward.

More interesting to me is the nature of the Medicaid Expansion bill. It is not a Medicaid Expansion bill. It is a health policy bill. It is a dessert and vegetable bill where everyone gets some dessert and everyone has to eat some vegetables at the same time. The really nifty thing from a political and policy point of view is that what is the dessert and what are the vegetables varies significantly by stakeholder and Senator. This is nifty!

The first chunk of the bill is Medicaid Expansion, work requirements (that will get denied by the Biden Administration) and the hospital taxes to pay for the state share of the expansion. There is a turn-off valve provision to shut down Expansion if the Federal share ever goes below 90%. So far this is a Medicaid Expansion bill.

However the next chunk of the bill is on provider market regulation. Certified Registered Nurse Practitioners and Physician Assistants will have a much wider scope of practice. The construction of new facilities will have fewer regulations that currently favor local incumbents. There will be changes in billing transparency. And finally there are some pretty big changes to telehealth including a requirement that insurers pay clinicians parity rates for telehealth visits and in-person appointments.

There is a little bit for everyone to love, and a little bit for everyone to hate in this bill. The bet is that there is more to love (although it may be different things loved) then hated intensely. The big question after this is what will the state house do?