People protesting the Senate's plan to enact sweeping restrictions on abortion access outside the front of the legislative building in Raleigh.
People protesting the Senate's plan to enact sweeping restrictions on abortion access outside the front of the legislative building in Raleigh. Photo credit: Rose Hoban

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Senators filed more than 300 bills this week as they bumped up against their filing deadline.

By Rose Hoban

Everyone has deadlines: Taxpayers plan ahead for April 15, reporters need to file stories for publication by a certain time and lawmakers have deadlines to file bills for consideration during legislative sessions.

On Thursday, the North Carolina Senate had a deadline for bills that are not finance bills (those can be filed later) or local bills (those also can be filed later). Originally, the drop-dead time was 3 p.m. Then it was pushed until later in the afternoon. Finally, the bills stopped flying somewhere around 5 p.m.

By the time it was all done, 194 bills had been filed on Thursday alone. And at least 52 of the total 351 bills filed just this past week have health care implications, from proposals to oversee donations of venison to charities to defining sexual consent, to regulating opticians, to remaking the state’s Medicaid program.

Not every bill that’s filed will become law, and many are simply desires put down on paper or statements made to be used in the next campaign. But a look at the bills gives an idea of what lawmakers are thinking about.

Dueling Medicaid plans

Senators filed at least four different Medicaid reform bills on Thursday, laying bare the philosophical differences over how to change the program that persist despite close to two years of discussion.

Medicaid provides health care for close to 1.8 million low-income children, some of their parents, pregnant women and low-income elderly.

Chairs of the Senate Health Care Committee have their bills, with Sens. Louis Pate (R-Mt. Olive) and Tommy Tucker (R-Waxhaw) supporting a bare-bones bill with general language that has its origins in the Medicaid reform subcommittee process that took place last fall. That measure has a companion bill in the House with the same language and is sponsored by leaders from the House Health Committee.

Another co-chair from the Senate Health Care Committee, Ralph Hise (R-Spruce Pine), has filed his own version of a bill to “Modernize Medicaid”. Hise’s bill pulls administration of the Medicaid program out from the Department of Health and Human Services and creates a separate Health Benefits Authority with appointed members to oversee the program. That bill would move doctors, clinics and hospitals from getting paid on a fee-for-service system to one that places providers at “full financial risk” for managing costs, while improving their patients’ health care outcomes.

Hise calls for implementation of the new system over a four-year time period.

Hise has also filed a companion bill that would forbid the state from contracting with Community Care of North Carolina. That organization currently manages the care for many of the state’s Medicaid children and non-disabled adults using the medical-home model that has been found to save the state money and has been emulated in a number of states.

Yet another member of the same committee, Jeff Tarte (R-Cornelius), has filed a bill that would “Modernize Health Care,” containing a broad brush plan for Medicaid’s makeover. Tarte’s plan includes retaining Community Care of North Carolina but also includes creating “At-Risk Provider-Led Organizations,” which, similar to Hise’s plan, would expose doctors and hospitals to financial risk in organizations led by the health care providers themselves.

Different from Hise’s plan, though, Tarte’s plan would keep Medicaid administration within DHHS. Instead, his plan would create a legislative oversight committee to monitor the budgeting, finance, administrative and operational issues in the program.

In what is perhaps a reflection of the difficulty of designing a new governmental program within a bill proposal, Tarte’s bill retains parenthetical notes such as: “not clear who picks them or how they are regulated” and “suggest a more specific entity to report to, like HHS Oversight Committee or Fiscal Research.”

Finally, Senate President Pro Tempore Phil Berger (R-Eden) filed his own “Medicaid Transformation” bill that would change the program from the current fee-for-service payment system to one run by commercial managed care companies.

That bill is one of only six sponsored by Berger during this session.

Courting controversy

A number of the bills have the potential for being controversial, among them a measure to require physicians performing abortions to submit documents to DHHS for each abortion performed after 16 weeks gestation. The documents include ultrasound images of the fetus, detailed diagnostic information and additional justification for abortions performed after 20 weeks of pregnancy.

The bill also institutes an regimen of annual inspection of abortion clinics.

Another bipartisan bill seeks to define rape, including the stipulation that “a person may withdraw consent to engage in vaginal intercourse in the middle of the intercourse, even if the actual penetration is accomplished with consent.”

And Sen. Norman Sanderson (R-Arapahoe) seeks to make it a crime to sell any kind of devices that might be used by someone to commit suicide, such as products known as “thanatron,” “mercitron,” “deliverance machine” and “exit’s euthanasia device.” The bill makes it clear, however, that withdrawing or withholding legitimate medical treatment does not constitute assisted suicide.

Once more, with feeling

A number of bills are reappearing from prior legislative sessions, including a bill first introduced last year to reduce the copay for cancer drugs administered on an outpatient basis to be more comparable to intravenous drugs administered in hospitals and clinics.

Families who have children with autism could benefit from a bill that would require insurers to cover up to $40,000 worth of intensive therapy. That bill was first introduced in 2013, passed the House and was sent to the Senate, where no action was taken on it during the 2014 short session. Advocates say they are hopeful the bill will be successful this year, given that one of the Senate co-sponsors is the powerful chairman of the Senate’s Rules and Operations committee, Tom Apodaca (R-Hendersonville).

 

 

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