By Hyun Namkoong and Rose Hoban
Lawmakers returned to Raleigh on Wednesday to start the new legislative session. And while education and tax policy appear to be the top priorities, there was plenty of talk about in regards to the future of the state’s Medicaid program and other health care priorities.
Leaders of both programs expressed doubt about expanding Medicaid, which pays for the health care of about 1.8 million low-income children, their parents, seniors and people with disabilities. But other members had plenty to say about the future shape of the program and the reform discussion that’s been taking place for the past year and a half.
“I think that the issue of Medicaid expansion is one that we’ve answered time and time again,” said Senate President Pro Tempore Phil Berger (R-Eden) during a press conference after his chamber had recessed for the day. “I don’t see that the answer is any different at this point.”
Berger said that there’s “no good case that can be made that Medicaid expansion is the right thing for us to do.”
Newly elected House Speaker Tim Moore (R-King’s Mountain) concurred with Berger, saying he continued to be “unconvinced” that Medicaid expansion is a good idea.
From the other side of the aisle, minority leader Larry Hall (D-Durham) said Democrats believe that expanding Medicaid would create more job opportunities and a healthier workforce. Democrats have new data to back up their argument: a study commissioned by the Kate B. Reynolds and Cone Health foundations that says North Carolina is losing about $22 billion in economic activity as a result of not expanding.
Gov. Pat McCrory has also publicly floated the idea of expanding Medicaid, on the condition, he said, that state federal health officials agree to a waiver that would allow for leeway in shaping the program’s future.
“[Democrats] have sense enough to know that we can’t pass Medicaid [expansion] in North Carolina,” said Senate minority leader Dan Blue (D-Raleigh), who suggested that the governor is becoming a shrewd negotiator with legislators.
“It’s going to take the governor’s leadership, and I will pledge to him … the cooperation of our caucus in taking the state where it needs to go with respect to Medicaid,” Blue said.
Reforming Medicaid
Another looming issue for the legislature is the question of what Medicaid will look like in the near and distant future. But the leaders of both chambers were less definitive on where the middle ground on Medicaid will be. Disagreement between the House and Senate last summer delayed the end of the legislative session.
Berger told reporters he didn’t know what reform would look like, but Senate health care committee members have championed a plan that would open the door to for-profit managed care companies to run parts of the program.
In contrast, members of the House have thrown their weight behind a plan that favors the establishment of accountable care organizations.
ACOs are a way of organizing the delivery of health care services that ties quality measurements and patient outcomes to reimbursement for care. If the ACO is successful in improving efficiency along with the care and health of patients, the organization keeps any extra reimbursement.
Department of Health and Human Services Sec. Aldona Wos also favors this plan, and has called on the legislature to make ACOs their choice for Medicaid reform.
“If any of us in the room had the answer to this problem, we’d be pretty well off,” Moore said. “You’re going to see us work together and collaborate as much as we can between the two chambers to try to find a solution.”
But a committee process this past fall found persistent differences between the two chambers’ visions of Medicaid’s future.
“What it’s going to look like, I don’t think either of us can say at this point,” Moore said.
Some members of Moore’s caucus are urging the legislature to go slow and make incremental tweaks to the program rather than do a wholesale upheaval.
“My suggestion is that we work on things in the current setting that will accomplish a lot of benefits and give some sort of stability to the program for a while as we work through the [Affordable Care Act] changes that have happened,” said Rep. Marilyn Avila (R-Raleigh), who sits on the Joint Legislative Oversight Committee on Health and Human Services.
She also noted changes that the newly elected Congress might be making to Obamacare, as well as an upcoming Supreme Court decision on King v. Burwell. That case pertains to the legality of tax credits for people buying insurance on the federal exchanges. A decision on the case is due in June.
Other priorities on the table
Just this past week, McCrory announced a deal with the city of Raleigh for the city to purchase the property that housed the Dorothea Dix Hospital. Mental health advocates have been pressing for some or all of the proceeds from the sale to go to pay for mental health services.
Berger said the Dix property is an asset and that the state should profit from its sale. Raleigh has offered $52 million to purchase the 308 acres of prime real estate on the outskirts of downtown.
“It’s a state asset that everyone acknowledges has value,” Berger said. “We want to be sure that taxpayers of the state receive fair consideration for a transfer that takes place.”
“I know it’s been mainly an issue of interest here in Raleigh,” said Moore. “There’s been nobody beating my door down about this issue.”
Moore also said he’s in favor of legislation to make it possible to electronically file death certificates, as requested by the state medical examiner.
“As a small-town attorney, I handle estate cases for people all the time,” he said. “If you’ve got a situation that you need a death certificate to get something started because of some pressing legal matter, the delay really is a problem. So we need to find a way to fix it.”
But Moore said that he had been unaware of the $5.9 million price tag for an upgrade from paper records and the need for about a half-million dollars a year to operate the electronic system.
“I guess in the big scheme of a $21 billion budget, that’s not that much money,” he said. “Why it would cost $5 million? I don’t know.
“I’ve always thought that with some of these cost projections, how much things cost, maybe I’m in the wrong business.”
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