RALEIGH, N.C. (WGHP) – The Medicaid expansion bill that the North Carolina Senate approved almost unanimously earlier this month won’t get a hearing in the state House.

After a meeting of the Republican caucus, leadership decided to forego the bill backed by Senate Leader Phil Berger (R-Eden) and take a new pass at expanding Medicaid – but only that, state Rep. Donny Lambeth (R-Winston-Salem) said late Wednesday.

State Rep. Donny Lambeth

The House Health Committee meets on Thursday, and Lambeth is not only one of the co-chairs of that committee but also one of the sponsors of the original House Bill 149, which the Senate augmented earlier this month.

“We do not plan to take up the Senate bill related to expansion,” Lambeth wrote in an email to WGHP. “The House will have an option for committee discussions only that might be a reasonable compromise to keep the interest level active as members in the House look for a pathway to expand Medicaid and Medicaid only without some of the other items in the Senate bill.”

State Rep. Cecil Brockman (D-High Point), a member of the committee, also indicated he expected the matter to be taken up but without a vote.

The Senate passed the Expanding Access to Healthcare Act on third reading by a vote of 44-1 exactly three weeks ago Thursday. But even then House Speaker Tim Moore (R-Cleveland) had said there wasn’t much “appetite” for the bill.

State Senate Leader Phil Berger (R-Eden) (Courtesy of NC General Assembly)
State Senate Leader Phil Berger (R-Eden) (Courtesy of NC General Assembly)

Lambeth said at the time that he had “worked on some variation of an expansion bill for 8 years: and that he was “pleased that they have finally understood the benefits to NC and our citizens.” But not so fast.

Berger and Sen. Joyce Krawiec (R-Kernersville), two longtime opponents of Medicaid expansion, had gotten behind this new bill, largely because, Berger said, the Medicaid program was fulfilling its promise under the Affordable Care Act and that the ACA “wasn’t going anywhere.”

Krawiec’s enthusiasm was because the bill provided help for rural health care to provide for telehealth services, an easier path to opening new facilities and more options for nurse practitioners. It’s unclear what specifics the House would not consider and inspire the creation of a new version.

The Senate’s bill

These are the provisions of the bill the Senate passed:

  • Expands Medicaid for individuals earning up to 138% of the federal poverty level ($38,295 for a family of four).
  • Establishes a program to invest at least $600 million from the federal government – and potentially as much as $3 billion – to bolster North Carolina hospitals.
  • Requires the 10% state share to be paid for through modernizing the state’s existing hospital assessment in addition to enacting a new one on hospitals.
  • Requires transparency in the form of annual reports from the Department of Health and Human Services on the financials of the program.
  • Gives the DHHS Secretary the ability to end expanded coverage if the state share cannot be covered.
  • Establishes a work requirement to receive expanded coverage, similar to work requirements already in law.
  • Reforms the state’s Certificate of Need laws by creating two separate application pathways.
  • Stops surprise medical bills by requiring healthcare facilities to inform patients if they are scheduled to see out-of-network providers.
  • Requires health insurance providers to cover telehealth services. 
  • Allows advanced practice registered nurses to practice at the top of their license – granting them full practice authority.

The only senator to oppose it was Norman Sanderson (R-District 2), who represents Carteret, Craven and Pamlico counties. Gov. Roy Cooper has been an advocate for Medicaid expansion, but he has not commented.