A Republican proposal to expand Medicaid in North Carolina advanced again on Wednesday with bipartisan support in the state House. But it's unclear whether reviving the idea will erode strong opposition from the Senate's GOP majority.
The expansion measure approved by the House Health Committee is similar to a bill the panel heard and approved in July. The earlier proposal got sidelined as the state budget impasse intensified.
North Carolina is one of 14 states that haven't accepted funds through the 2010 federal healthcare law to cover adults who make too much money to qualify for traditional Medicaid but not enough to get subsidized health insurance exchange policies.
Just like the previous proposal, Wednesday's measure says qualifying low-income adults must meet work or training requirements and pay premiums equal to 2% of household income. Hospital and health insurers would cover the state's share to draw down the federal funds equal to 90% of the program's cost.
In a strategy to attract even more GOP support, provisions were added to halt expansion if federal Medicaid regulators or courts later prevent the bill's key requirements from being carried out. Work requirements in a few states have been struck down, for example.
"Those poison pills are actually an important piece ... to try to build the support that you need to get this done," Forsyth County GOP Rep. Donny Lambeth, the chief proponent of the expansion measure, said after the committee vote. A few Republicans still voted no.
The proposal considered in July would help qualify 300,000 people for expanded Medicaid coverage. Lambeth said on Wednesday the updated bill would target roughly the same number.
Many committee Democrats still voted for the plan after offering amendments that were defeated to eliminate or modify work requirements or do away with premiums. Monitoring these requirements could be costly for the state Medicaid office and complicate things for recipients working multiple jobs, one legislator said.
"This adds another level of hardship for them," said Rep. Becky Carney, a Mecklenburg County Democrat. Lambeth said he would consider adjustments to expand work requirement exemptions before the bill comes to the House floor, probably in early October.
The expansion measure approved in July — which like Wednesday's bill also would ultimately set aside $50 million annually for rural healthcare grants — got bogged down in the budget stalemate. Democratic Gov. Roy Cooper vetoed the budget because in part because it would not expand Medicaid.
As an enticement for Democrats supporting expansion, House Speaker Tim Moore said two months ago he'd allow a vote on an expansion bill if the budget veto was overridden in the chamber.
Republicans unexpectedly voted to override the veto last week when dozens of Democrats were absent from the floor. After the vote, Moore said he'd revive the Medicaid expansion measure, even though the Senate hasn't yet voted on a budget override.
Senate leader Phil Berger, a longtime expansion opponent, has said repeatedly there aren't enough votes in his chamber to approve the idea. Lambeth acknowledged Republican senators will be tough to win over but said he believes they're open to "other creative options" to reduce the number of uninsured citizens.
"Basically, what Speaker Moore has said to me was, 'Don't worry about the Senate. Do what you think is right for the House. And we'll deal with the Senate if we get to that point,'" Lambeth said.