Doctors fill the gallery at the senate during the debate over rejecting Medicaid expansion and other provisions of Obamacare

Senators debated a bill to reject all aspects of Obamacare Monday night, passing by a mostly party-line vote. The bill comes up for final vote Tuesday.

By Rose Hoban

State senators voted on a proposal to reject aspects of the Affordable Care Act Monday night and calendared the bill for final consideration for Tuesday, despite a call from Governor McCrory to slow down on the bill.

With the chamber gallery populated with doctors wearing white coats and scrubs, senators voted 31-17 to move the bill forward after about an hour of debate. A final vote on the bill will be held Tuesday, according to Sen. Pete Brunstetter (R-Winston-Salem).

Senators debated a bill Monday night that would reject all aspects of the Affordable Care Act.
The Senate chamber at the General Assembly where senators debated a bill Monday night that would reject all aspects of the Affordable Care Act.

“I think we’ll take action on it tomorrow, and finish it up,” Brunstetter said.

An identical bill was proposed last week in the House of Representatives, although debate on that bill has not been scheduled.

The Monday night debate was unusual in that mostly, Monday evenings tend to be used for procedural votes and to accomplish legislative business.

Governor calls for slow down

The governor sent a letter to every senator Monday afternoon expressing concern about some of the costs of updating the state’s Medicaid computer systems. North Carolina would end up bearing more of the costs as a result of rejecting federal funds to create a health benefits exchange that’s been in the works since the fall.

In December, former governor Perdue decided to partner with the federal government to create the state’s exchange, required under the Affordable Care Act, commonly known as Obamacare.

But bills put forth in both chambers of the General Assembly last week would reject the state-federal partnership and instead have the federal government run the exchange,  the main mechanism that individuals will have to get insurance once the Affordable Care Act is fully implemented in 2014. The bills also reject the possibility of an expansion of the Medicaid program and order state agencies to turn down federal grants that would help pay for the planning process.

In his letter, McCrory expressed concern over the $43 million price tag for a new computer system that is planned to track eligibility for Medicaid and help detect fraud and abuse. The North Carolina Families Accessing Services Through Technology (NC FAST) system would have been paid for completely by federal planning grants. Some federal money will could be available to help with implementation of the federally mandated system, but more of the burden will fall on North Carolina.

“This bill would force the state to apply for a new funding stream for NC FAST, which is not a guarantee, and may delay NC FAST and generate additional costs through labor-intensive manual workarounds,” wrote Fred Steen, McCrory’s legislative liaison.

“We believe additional time is necessary to evaluate the serious financial ramifications of Senate Bill 4 to North Carolina taxpayers,” the letter said.

Senators also received letters from the North Carolina Hospital Association Monday afternoon, asking them to reject the bill, and making the point that “the decision to not expand Medicaid will harm your community hospitals’ ability to meet our patients’ and community’s health needs.”

“Hospital will be foreced to eliminate services and lay-off employees. Hopefully, none will be forced to close,” the letter read.

White coat syndrome

About 75 doctors and medical students came to observe the debate, filling one half of the gallery that overlooks the Senate chamber.

Doctors waited for Senators outside the chamber doors after the vote to reject aspects of the Affordable Care Act.
Doctors waited for Senators outside the chamber doors after the vote to reject aspects of the Affordable Care Act.

“We see these people that our representatives are voting on every day,” said Loren Robinson, chief pediatric resident at UNC-Chapel Hill’s medical school. “There’s power in numbers and there’s power in us showing up here tonight.”

Robinson said she sent about a thousand emails to other residents and doctors encouraging them to contact their legislators about the bills, and show up at the legislature.

The doctors were admonished at one point after they applauded comments opposing the bill by Sen. Josh Stein (D-Wake).

“I see people every day who could benefit from North Carolina expanding Medicaid,” said Melissa Bishop a the lead physician at the Piedmont Health Services clinic in Moncure. She said 59 precent of the patients at her clinic are uninsured.

Bishop described a call she received over the weekend from a patient who was having seizures, and his blood sugar and blood pressure were both dangerously high.

“And they had to decide which medication to give him because he couldn’t afford to treat his seizure disorder and his high blood pressure and his diabetes, so they opted to give him the seizure medicine,” Bishop said.

“These are decisions that people are having to make.”

Slatkoff was there with her old instructor, Susan Slatkoff, who teaches residents at UNC-Chapel Hill.

Slatkoff called the idea of not expanding Medicaid “an outrageous idea, especially when there’s gonna be money from the federal government that would not be out of North Carolina’s pockets to cover 500,000 people who aren’t covered right now. And it will not cost the state a penny.”

Both women said they had never been to the legislature but said they may be making their ways back this year.

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Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...

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