By Liora Engel-Smith and Rose Hoban
After a week of being out of Raleigh and back in their districts, lawmakers returned to the General Assembly and almost immediately resumed the sniping over the budget and Medicaid that’s marked the summer.
Even as Democrats were holding a meeting with an out-of-state expert who has crunched the numbers on how Medicaid expansion would affect North Carolina, Senate Republicans held a press conference to explain their plans to pass piecemeal budget bills and recess by Halloween.
As for Medicaid, Senate leader Phil Berger (R-Eden) said he remained opposed to the policy that could sweep as many as a half-million low-income workers into the program.
“We do not think that Medicaid expansion that has been sent to us by Washington and has been passed by other states is the answer,” he told reporters. “We feel that there are fiscal problems with that approach.”
That expansion, created by the Affordable Care Act, allows states to extend Medicaid benefits to people earning below 135 percent of the federal poverty level (about $16,860 per year for an individual, $34760 for a family of four). Usually, Medicaid covers low-income children, some of their parents, many people with disabilities and needy seniors.
Currently, a bill in the House of Representatives would use Medicaid to allow low-income workers to buy into the program by paying small premiums and copays. People would be eligible so long as they were working, going to school, in a drug treatment program, or engaged in caregiving.
Berger did open the door just a crack when he told reporters, “we are looking at ways to try to cover folks that are in that gap, that working poor gap.”
But he also called work requirements in the House bill “window dressing.”
“I just do not see them being an effective provision,” he said, noting that courts have struck down work requirements enacted by other states.
‘We know what works’
Meanwhile, in an almost-full conference room on the other side of the legislative building, roughly 30 Democrats sat down to rehash many of the arguments they have been making all summer: Medicaid expansion is good for the economy, it’s good for North Carolinians, and the federal government will pay the bulk of it, with hospitals and insurance shouldering the rest of the bill.
The meeting, which, according to a staffer from Sen. Dan Blue Jr.’s (D-Raleigh) office, had been organized with the help of the N.C. Department of Health and Human Services, was meant to move the expansion conversation forward. Representatives from the state health department were not immediately available for comment, but DHHS Sec. Mandy Cohen has been a vocal supporter of expansion.
Though Republicans were invited, none made their presence known.
Lawmakers heard from George Washington University health economist Leighton Ku, who studied the impact of the expansion on the state. Calling it an “economic boon” Ku said expansion would cover a significant chunk of uninsured adults in the state. He also reckoned extending coverage could stabilize flailing rural hospitals and increase economic activity in the state by an estimated $3 billion. Expansion, he said, could help the state combat the opioid crisis and improve health outcomes for low-income adults.
Residents across the state already paid $8 billion in taxes that funded expansion in other states, he argued, yet they get none of the benefits.
Rep. Darren Jackson (D-Raleigh), who co-hosted the hearing with Blue, echoed these statements earlier in the hearing.
“Time and time again, our delegation in Washington is taking federal dollars,” he said. “Money for infrastructure, money for education and we apparently have no problem when it comes to asking for those dollars. Health care, however, is just as significant a challenge. The federal funds are already approved. So imagine that all we have to do is ask.”
The meeting also included statements from a woman who lost her daughter to a drug overdose, a child care facility owner who lost uninsured co-workers to preventable diseases, and a single mother from Alamance County who is in the so-called Medicaid gap.
“If you were able to negotiate a compromise in terms of this Medicaid expansion that we’ve been toying with here at the General Assembly, what would you be willing to give up?” asked Rep. Jean Farmer-Butterfield (D-Wilson).
Cassandra Brooks, the child care facility owner, said she was against introducing work requirements, especially when lives are in the balance.
“When you think about a person’s life and a family’s life, how do you put it to quantitative matters? I have two families that don’t have a mother anymore,” she said. “I have two husbands who don’t have a wife anymore.”
Then, Sen. Mike Woodard (D-Durham) brought up Berger’s press conference.
“If he were here instead of at a press conference, what would you share with him … ?,” he asked Robin Jordan, a nurse who lost her daughter, Jessica, to a drug overdose last year.
“I watched my daughter struggle throughout her entire adult life and it became just a vicious downward spiral,” she said. “She did not qualify for Medicaid … there are people who need help and can’t care for themselves and some of those requirements will prevent medical coverage.”
Correction: In our original caption for a photo, we mis-identified Leighton Ku’s university. He is a health economist at George Washington University, not Washington State University, and we have changed the caption. His affiliation was correct in the original story.
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