By Rose Hoban
After years of trying, a group of moderate Republicans in the state House of Representatives finally held a committee hearing on expanding the state’s Medicaid program to cover about a half million additional low-income residents.
In a lopsided 25-6 vote both Republicans and Democrats moved the NC Health Care for Working Families Act through the House Health committee Tuesday morning after about an hour of presentations and debate.
“This [bill] assumes about 300,000… who are working would take advantage of this product,” said Rep. Donny Lambeth (R-Winston-Salem), a former hospital president. He is also one of the four sponsors of House Bill 655, a version of which was first introduced in 2017.
“[It] generates $4.7 billion into North Carolina, economically to cover many of our health care woes.”
Lambeth went on to estimate that another 200,000-plus other low-income workers who spend significant portions of their salaries on health insurance would take advantage of the Medicaid program coverage instead. All these new beneficiaries would be paid by new hospital and insurer assessments, and by federal funds that would cover 90 percent of the costs, leaving the state off the hook.
“Thirty-six states have expanded or some version of expansion or modification, there are only 14 states left that have not, we’re one of those 14,” he said. Lambeth explained that it would take until the middle of 2020 to get all of the federal approvals and get all the pieces in place to make the expansion complete.
“We have to start somewhere,” he said.
But by the end of the day, there was a good chance that somewhere may actually be nowhere.
After the morning meeting, the bill was fast-tracked to the House floor, skipping other committee referrals. Lambeth expressed confidence that the bill had the votes – both Republican and Democratic – to pass that chamber.
But once it got to the House of Representatives, HB 655 got caught up in the politics of this year’s state budget, which was vetoed by Gov. Roy Cooper on June 28.
By the end of the day, the fate of Medicaid expansion looked as dim as it has since members of the state’s Republican majority cut the governor’s office out of the deliberations in early 2013.
Tit-for-tat
Even as legislators were discussing Medicaid expansion in committee, Cooper started a press conference to discuss his counter-proposal to the lawmakers’ budget. His chief complaint: The General Assembly budget failed to expand Medicaid.
Cooper also said he didn’t like the Medicaid expansion bill being heard in committee as it contains a work requirement, along with copays and premiums for beneficiaries.
“I would rather a pure Medicaid expansion and here’s why, it costs more to enforce premiums and work requirements than it’s worth, we’ve seen that in other states,” he told reporters. “In addition, most of the people we’re talking about here, the vast majority already are working.
“But those are items that can be discussed as we continue to negotiate this budget,” he said in response to a question about whether he’d accept work requirements in exchange for expansion.
In the days since Cooper vetoed the budget, he’s been caught up in a tit-for-tat with the legislature. Almost daily, one side or the other has issued press releases decrying the other, making accusations of bad faith in the budget negotiation process, accusing the other side of holding bills “hostage.”
“The problem is that we have not had a negotiation,” Cooper said. “We had no idea what their budget was going to be. Now, we know. Now we can offer specific compromise.”
Cooper’s staff sent out a one page handout specifying the governor’s negotiating positions on the budget, with Medicaid expansion as the top line. The list also included restoring cuts to the Department of Health and Human Services and revising a proposal to move the department, with its thousands of employees, out of Raleigh to rural Granville County.
Two issues intertwined
But all of these negotiating positions are contingent on Democrats in the legislature sustaining Cooper’s veto. In the legislative building, Republicans have been offering bargains to Democratic lawmakers, offering sweetheart local projects in exchange for budget votes. In the House of Representatives, Republicans would need to get seven Democrats to vote with their side to get to the 72 votes needed for an override.
“In my time here in 10 years, I have never seen hundreds of millions of dollars being offered to members, for a change of one vote,” said House minority leader Rep. Darren Jackson (D-Raleigh). He said that the DHHS relocation, which would come with thousands of jobs, had been offered to Democrats in at least five counties: Granville, Forsyth, Wayne, Cumberland and Harnett.
All day, Democratic lawmakers were in and out of House Speaker Tim Moore’s (R-King’s Mountain) corner office, only to be confronted by their fellow party members in the hallways afterward. At times, some lawmakers looked distressed, fingers were pressed into chests, exchanges became heated. One lawmaker looked ready to cry.
“I wish people would just vote or say, ‘I’m sticking with the governor,’” Jackson said, admitting he wasn’t always convinced he had the votes to sustain the veto. He noted that he’s had to be sure to get all of his members to Raleigh and present in the chamber, with some reluctant to leave to go to the bathroom.
At times during the day, exchanges on the House floor between Jackson and Moore became testy, as the two sparred over rules and procedures. Almost all the 29 bills on the calendar received votes, except for the budget override and the Medicaid expansion bill.
Moore told reporters during an impromptu press conference on the House floor that he was ready to hold the vote on Medicaid. But he also told reporters he didn’t want the vote on expansion until he had assurances from Democrats that the votes to override the budget veto were there.
“I … put a Medicaid bill on the calendar to show good faith today that we’re ready to move,” he said. “You know, a lot of my members here are getting bullied, getting bullied by the governor’s folks not to be able to vote their conscience on this bill.”
Brick wall
But even if the Medicaid expansion bill were to have passed in the House, it would run into the brick wall of the Senate. Phil Berger (R-Eden), the leader of that chamber’s majority Republicans, said he wants the governor to call a special session on Medicaid expansion and discuss it separately, once the budget is passed.
By the end of the day, Moore could not convince enough Democrats to vote to override the governor’s budget veto in order to move onto the Medicaid expansion bill. Photo credit: Rose Hoban
“I have told him we will not pass Medicaid expansion because the votes don’t exist for that,” he told reporters. “So we can have a discussion about the kinds of things that need to be done in order to increase access to care. But if the only way that can take place in the governor’s mind is through Medicaid expansion, then there’s not any prospect of us having any real success in negotiations.”
For the past week, Berger’s office has delivered a steady stream of press releases excoriating the governor into reporters’ inboxes.
“I personally handed [Cooper] my opening offers on his top priorities and asked him for a counter offer,” read a release from Berger dated July 8. “He refused to give one and instead blocked teacher and state employee raises, rape kit testing, and school construction funding over his Medicaid ultimatum. If a veto override fails, we’ll negotiate with Governor Cooper when he stops holding the entire budget hostage.”
Throughout Tuesday afternoon, senators were in recess, waiting for movement in the House that never came as the horsetrading continued. As they milled in and out of the Senate chamber, other Senate Republicans reiterated Berger’s position: not enough votes to pass Medicaid expansion.
“I haven’t changed my [cell phone] number. And [Cooper] hasn’t changed his but we have not talked directly in the last several days,” said Berger.
In the afternoon, Berger left the building and boarded a plane for a meeting in Germany; he returns next week.
Eventually, Moore adjourned the House for the day, still unable to override the veto. He reminded reporters that in the 2016 budget there was a provision that continues the state budget from one year to the next, continuing the functioning of state government. So, even if the current budget fails to become law, there’s a way forward for state spending.
Moore said that on Wednesday, he would present a stopgap funding measure so that even in the absence of a new budget, federal funding will continue to flow to the state.
But for Medicaid expansion, the way forward remains unclear, if there’s a way forward at all.
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