By Rose Hoban
Amid the smiles, photographs, receptions and family members crowding the legislative building in Raleigh on Wednesday, lawmakers involved in the making of health care policy said they were readying their lists of priorities for the legislative biennium that began this week.
The topmost issue on both sides of the aisle? The seemingly perennial issue of the past decade: whether North Carolina would ever join the majority of states and expand the Medicaid program to provide coverage for more than half a million low income workers.
Senate leader Phil Berger (R-Eden) highlighted Medicaid expansion in an address after being elected as leader for the seventh time since 2011, saying it was one of the issues the legislature “must tackle.”
“I support expanding Medicaid in North Carolina,” he told a capacity crowd in the Senate chamber.
Berger spent a decade opposed to the measure, but he changed his stance in 2022. He shepherded his bill through the Senate last year, only to have it hit a dead end in the House of Representatives.
“We must recognize that it is not a silver bullet,” he continued. “North Carolinians are saddled with some of the highest health care costs in the country. We need to eliminate regulatory red tape and other bureaucratic barriers that impede access to care and unnecessarily increase medical costs.”
Berger’s 2022 Medicaid expansion bill also included provisions that would 1) overhaul rules around hospital competition in North Carolina and 2) give advanced practice nurses more latitude to work independently of physicians.
In a media gathering after the swearing-in ceremony, Berger reiterated his position.
“In order to get … the broad bipartisan support that we had for the Medicaid expansion bill that we had before, there have got to be some measures that address the supply side,” he told reporters. “If you’re going to give 500,000, 600,000 people an insurance card that says they have a right to have their medical care paid for, then we need to do something to hopefully open up more access to more primary care providers, more facilities where they can be treated.”
Old differences could reemerge, though, as members of the House and Tim Moore (R-Kings Mountain), the re-elected House speaker, talked about a “clean” Medicaid expansion bill that does not include mention of nurses or hospitals.
Rep. Donny Lambeth (R–Winston-Salem) acknowledged that some of Berger’s concerns will need to be addressed before the two chambers come to any agreement. House committee assignments have not been announced, but Lambeth has been a key player from the House in committees with members from both legislative chambers tackling health care issues.
“I think we have to do the certificate of need reform,” he said, referring to the laws on hospital competition. “So my second bill will be a certificate of need bill that I’ve been working on with the industry. And I think we’ve got to get that one done in order to do expansion.
“That was kind of the Senate feedback.”
Mental health on many minds
Republicans and Democrats noted the importance of addressing mental health needs across the state.
Lambeth said he recently attended a forum on mental health best practices with representatives Carla Cunningham (D-Charlotte), a nurse, and Wayne Sasser (R-Albemarle), a pharmacist. Lambeth said they were interested in implementing some things other states are doing.
“I think we need more psychologists in schools, because I think we need to reach out to these kids and listen to these kids in a more proactive way,” Lambeth said. “We’ve talked about having more guidance counselors and psychologists in schools, and we’ve done a little bit of that. But I do think we need more.”
Lambeth also would like the legislature to consider funding mental health crisis centers.
“We’ve seen suicide rates grow exponentially in the last several years, and COVID did not help anything,” said Sen. Sydney Batch (D-Apex), who is a social worker and family law attorney. She’s been appointed to the Senate Health Care Committee.
“Children are sitting in hospitals for way too long not having appropriate placements,” Batch said. “We have a mental health crisis in the foster care system. And then also just within our schools every single day, we need to actually have mental health professionals seeing the children, identifying them and addressing their needs.”
Batch filed a bill in the last session that would have given mental health providers treatment spaces in schools, prioritizing children who lack health insurance or a regular care provider.
“My real concern is that… everybody’s talking mental health, but we just say the same redundant words over and over again,” said Rep. Donna White (R-Clayton), a nurse who has played a key role in shaping legislative health care policies. “We just don’t try to find out what’s causing the mental health issues in our young people.”
Lists are long
Rep. Hugh Blackwell (R-Valdese) said that during the swearing-in festivities he started jotting down on a scrap of paper a list of priorities that he wants to work on in the coming biennium. House committee assignments haven’t been announced, but Blackwell said he expects to again be appointed to health care committees.
At the top of that list were mental health issues, but he ticked off a number of other topics, including getting patient information at state-operated health care facilities onto electronic health records.
Another one of his concerns was about staffing in health care.
“I think, at Broughton Hospital, for example… that we’ve got maybe over 100 beds that are not being used that could be, because we haven’t got the staffing for it,” Blackwell said.
Last year, leaders at the Department of Health and Human Services signaled to lawmakers that they faced significant staffing shortages across all of their divisions, including in state-operated hospitals.
Sen. Jim Perry (R-Kinston) also had health care workforce issues on his mind, and he mentioned the shortage of child care workers.
“The availability of workforce, qualified individuals to work in those facilities, [of] affordability — wages have just gone through the roof,” Perry said. “We’ve got to try to figure some things out… have a healthy workforce. Mom and Dad got to have someone taking care of the kids so they can go to work.”
Other health care topics that topped lawmakers’ lists included:
- Addressing mental health issues faced by foster children, a topic raised by Batch and Sen. Mike Woodard (D-Durham). Woodard said he’s concerned about how kids in foster care have difficulty accessing health care if they move from one region of the state to another — something that Batch tried to address in a bill she championed last year.
- White said she’s ready to take another run at getting her chamber behind the SAVE Act, which would give more independence to advanced practice nurses. Last year, the bill had 75 co-sponsors in the House of Representatives, but it was never brought to the floor for a vote. “I believe that I could get that many [sponsors] this time,” White said. “I’ve not met all the freshmen and I don’t know what their views are about a lot of things, but it’s certainly a whole new group to consult with, and I’ll be doing that very shortly.”
- Lambeth said he’d like to address some of the issues around getting other health care workers into the educational pipeline. “One is physician manpower in rural areas. Whether we do loan forgiveness or other programs, we’ve got to do something to address the shortage in some of the rural areas,” Lambeth added. “We’ve met with some community colleges. What they’re telling me is ‘We’ve got the space, we’ve got qualified applicants, we don’t have instructors, we don’t have enough money.’”
- Abortion was mentioned by multiple lawmakers on both sides of the aisle. Woodard noted that Senate Democrats plan to file a bill codifying the constitutional protections for abortion overturned in last summer’s Supreme Court Dobbs decision. Republicans, for their part, talked about a range of possibilities for a possible bill limiting the procedure. “We’ll see what, if anything, is something that can be passed by the General Assembly and withstand a possible veto,” Berger said.
Wednesday was just the start of a process that will play out over the coming months and perhaps years. Many of the initiatives would take state funding, which will pit interest groups against each other — and lawmakers know how frustrating that can be.
“Everything requires money, and that’s why you can never do everything at once,” Perry said. “It’s not that something is or is not important, it’s just that resources are scarce.”