Short Legislative Session Will Have Plenty of Health Care Work

By Rose Hoban

At noon today, a gavel will drop in both chambers of the North Carolina General Assembly, marking the beginning of the “short” legislative session.

With House Speaker Thom Tillis preoccupied with his race against U.S. Sen. Kay Hagan and lawmakers in both chambers needing to fundraise and campaign for their fall re-elections, all indications are that the session will, indeed, be short.

Lawmakers return to Jones Street this week for the short legislative session. Photo credit: Rose Hoban

But legislative brevity is not guaranteed. And even if the session is short, it doesn’t mean nothing will happen.

Rep. Nelson Dollar (R-Cary) told reporters this week that the General Assembly committee process allows for legislative “multitasking.” He predicted that lawmakers would be looking at a number of issues besides adjusting the budget, which is the real reason they’re in Raleigh.

Legislators manage to pack quite a bit of activity into the six weeks before the end of the fiscal year on June 30. And that date doesn’t mean the session ends there. If there’s still work to be done, lawmakers can – and have in the past – stayed until long past July 1.

This year, there are several major health care issues at play and a number of small ones that have some broader significance.

Medicaid

The Department of Health and Human Services told lawmakers on the legislative oversight committee in March and April that this year’s budget overrun for the federal- and state-funded program that covers more than 1.4 million of North Carolina’s low-income, disabled and pregnant patients, would be in the neighborhood of $140 million, considerably lower than prior year cost overruns, which topped $400 million.

The estimate came late in the fiscal year; in prior years, cost overruns have been announced in January or February. But the new Medicaid billing and claims-management system, NCTracks, has been slow to produce data for forecasting the Medicaid budget.

Dollar cited the smaller deficit as an example of how Republicans have improved management of the Medicaid program since coming into power after the 2010 election.

Rep. Nelson Dollar (seated far l) was one of five members of the Medicaid Reform Advisory Group that helped craft the Medicaid reform plan. Photo credit: Rose Hoban

“When we came in in 2011,” he said, “we had spent well north of $750 million and, unbeknownst to us, there were still things off budget.”

Dollar also argued that problems with Medicaid have not been about the program itself but with how it’s administered by DHHS.

“In North Carolina, the growth in Medicaid has not been in claims; claims spending has been lower than the national average,” he said.

Dollar also hinted that the final Medicaid deficit could go even lower than the $140 million quoted by DHHS in April.

Despite improvements in Medicaid’s fiscal outlook, Republican leaders have not indicated they’re willing to consider expanding the program as allowed for under the federal Affordable Care Act.

“There will be some deals out there to expand Medicaid, I’m sure, and the discussions will be had,” said Democratic House leader Larry Hall (D-Durham). “We know what kind of jobs we lost by not expanding it. We hope that the priorities of the health of the people will come through in this session.”

Hall also said that some people will die prematurely because of lack of insurance. Health economists estimate that number to be as many as 1,150 people annually.

But Republicans have not indicated any willingness to expand Medicaid, citing the state of the North Carolina budget.

“I’m sorry, I’m not for expansion. Because we do not have the money; we just do not. Our state is broke,” Rep Pat Hurley (R-Asheboro) said at a legislative breakfast in April. “And yes, the money that we save goes back into your pocket.”

The other pending Medicaid issue is whether the legislature will green light a DHHS proposal to reform the state program, converting physician payment from fee for service. The plan calls for health care providers to organize themselves into “accountable care organizations” that would bear some financial risk if they’re not efficient in providing care and would gain financial rewards if they save money.

DHHS leaders remain optimistic they can get approval to move forward during the short session. But even though many House members, including Dollar, are fully behind the plan, he told reporters this week that getting it through both chambers during the short session would be a “tremendous amount of work.”

Tobacco

In 2012, legislators trimmed tobacco-prevention programs from a total of $17.1 million down to $2.7 million in 2013. Last year, those funds were further trimmed to a total of $1.2 million, to support the tobacco Quitline.

A man smokes an e-cigarette. Often the devices are made to look like traditional cigarettes. Photo by Taylor Dahlin, flickr creative commons

This year, advocates are back, asking for in increase in the tobacco tax to $1 per pack, which would raise an additional $351 million in revenue.

This week, legislators threw a wrench in the anti-tobacco campaigners’ plans when they moved along a proposed tax on e-cigarettes, electronic devices that produce a nicotine-filled vapor inhaled by users.

The bill would create a tax of 5 cents for each milliliter of the liquid used in e-cigarettes. At one of the most common concentrations of nicotine “juice” sold, one milliliter of the Marlboro-strength fluid can yield as many smokes as a pack of cigarettes. That means a bottle containing 15 milliliters of nicotine fluid would carry a tax of 75 cents but yield as many smokes as 15 packs of cigarettes.

In comparison, North Carolina taxes traditional cigarettes at $0.45 per pack, which is the fifth-lowest in the nation.

Other state have proposed far more aggressive taxes on e-cigarettes. In Washington, for example, lawmakers proposed a tax on the amount of nicotine in vaping fluid that would be the equivalent of about $28 for a 15-milliliter bottle.

Environmental laws

Last year, an omnibus bill to ease regulations on many environmental issues made its way through the Senate and then the House, where it was amended and sent back to the Senate, where it sat until the end of the long legislative session.

Among other measures, the bill allowed the legislature to look at regulations for water and sewer districts and consider ways to consolidate the districts and standardize regulations across the state, weakening stronger regulations created by some municipalities.

But in February, a coal ash pond owned by Duke Energy began to leak tens of thousands of gallons of coal ash into the Dan River near Eden, the constituency of Senate President Pro Tempore Phil Berger. The spill has drawn attention to environmental issues – in particular, water issues – in North Carolina.

Berger has said he’ll push for legislation that would force Duke Energy to clean up the spill and do something about coal ash in its 13 other locations around the state.

Environmental activists could use the spill to gain new power to push back against environmental deregulation.

Children’s health issues

Two bills that would affect children’s health have passed the House and await action in the Senate:

A bill to ensure that epinephrine pens are available in schools in the event of a child having a serious allergic reaction. That bill passed the House, 115-0.
A bill that would prohibit the use of tanning beds by anyone under the age of 18 years old. That bill passed the House, 94-22.

A bill that’s already proving contentious is a proposal that passed the House last year that would mandate that health insurers cover specialized treatment for children under 6 years old who are diagnosed with autism. That bill created divisions between the House and Senate during a committee meeting Tuesday, even before the session officially started.

Senate members of a committee examining the effects of the Affordable Care Act waited in vain for members of the House to arrive for a vote. The committee met twice on Tuesday, but failed to achieve a quorum. Photo credit: Rose Hoban

The bill passed the House last year with a 105-7 vote and was championed by Tillis, who is often seen wearing an autism-awareness lapel pin.

But the bill came under fire during a meeting of the Joint Study Committee on the Affordable Care Act and Implementation Issues on Tuesday as legislators proposed to place a moratorium on any insurance mandates, which would have affected potential passage of the autism coverage bill.

In an unusual occurrence, members of the House stayed away from the committee meeting in order to not vote on the bill. The absence of members resulted in a lack of committee quorum and the issue was tabled until Wednesday morning as lawmakers from both chambers hammered out a compromise.

As of publication, the bill is still in limbo.

Late Tuesday, legislative watchers were already commenting that this standoff could portend further conflict between House and Senate members as the legislature moves forward into the session.