NC Medicaid Expansion Is Back. But The Senate Isn’t Talking About It.

Some House members are quietly talking Medicaid expansion, but Senate Republicans remain resistant, despite the pandemic.

With the economic fallout of the COVID-19 pandemic leaving more than a million North Carolinians jobless—and thus, without employer-funded insurance—the Medicaid expansion debate has been re-energized in the North Carolina Legislature.

Last week, Sen. Jeff Jackson—a Democrat representing Mecklenburg County—addressed the issue during a health care virtual town hall, saying he’s seen bi-partisan support privately for expansion. And in recent weeks, a group of Democratic senators—Senate Democratic Leader Dan Blue, Sen. Valerie P. Foushee and Sen. Gladys A. Robinson—filed another Medicaid expansion bill in an effort to open up discussion in the Senate. 

RELATED: Legislature Isn’t Moving on Medicaid Expansion Despite ‘Bipartisan Consensus.’

“It’s our intent to discuss it again and do everything we can to move it forward,” Sen. Robinson, who serves on the Senate Health Care Committee, told Cardinal & Pine. “In terms of the Republican leadership, I think (Senate President Pro Tem Phil) Berger is where he was before, but it is our intent to discuss it with him.”

Expansion of Medicaid would mostly be funded by the federal government and could extend healthcare coverage to hundreds of thousands of North Carolinians. With the spread of COVID-19 in the state—which has more than 33,000 confirmed cases as of June 5—some have argued the need is more immediate than ever for expansion.

“The issues are even greater than before because a lot of the people who’ve gotten sick with COVID are blue collar folk who make too much money for Medicaid and don’t have enough for private insurance,” said Robinson. “Those are the folks in the coverage gap, and they need the insurance to get healthy and stay healthy.”

Most states have expanded Medicaid coverage under the ACA, with only 14 states—primarily in the South and Great Plains—refusing to do so. COVID-19 has reignited debate about Medicaid expansion in several of those states, including Missouri, which has introduced a ballot proposal for expansion set for voting Aug. 4, and Kansas, where Democratic Governor Laura Kelly has pushed for expansion against GOP opposition.

In April, North Carolina House Republicans, who’d previously opposed expansion of Medicaid eligibility in North Carolina under the parameters of the Affordable Care Act, began considering limited support for expansion.

“The whole issue of Medicaid transformation is something that most of the Republicans are interested in on the health care side.”

Republican House Speaker Tim Moore said he supported a limited expansion that would cover testing and treatment for uninsured COVID-19 patients, an idea first suggested by Rep. Josh Dobson, a Republican from McDowell County.

That followed a late-March request submitted by North Carolina Department of Health and Human Services Secretary Dr. Mandy Cohen to the Centers for Medicare and Medicaid Services to approve an emergency waiver under Section 1115 of the Social Security Act. The waiver would allow for coverage of care related to COVID-19 for anyone who earns less than 200 percent of the federal poverty level.

As recently as mid-May, Sen. Berger has expressed opposition to expanding Medicaid coverage in North Carolina.

Senate Health Care Committee Chair Joyce Krawiec heads one of the most pivotal committees in the legislature when it comes to Medicaid expansion. But Krawiec declined to comment for this story, calling Cardinal & Pine “fake news” in a statement Friday. 

Krawiec has served in the Senate since 2014, and has as recently as January expressed interest in reforming the state’s Medicaid policy to a managed care model, which she has said will save the state money. We also received no response from several other members of the committee.

Fellow member of the health care committee Sen. Don Davis, a Democrat representing Greene and Pitt counties, echoed Sen. Robinson’s sentiments, pointing out the impact on rural populations in counties like the ones he represents.

“The COVID-19 pandemic dramatically highlights the need to expeditiously move on closing the Medicaid coverage gap in North Carolina,” he said. “In such a trying time, closing the coverage gap will help keep rural hospitals open and limit unnecessary deaths.”

Sen. Robinson says she and many of her colleagues in the Senate want to come to a bipartisan agreement on expansion. 

“We haven’t really had a real discussion with Senator Berger and Senator Blue, and I plan to do that sometime in the very near future,” she said. “The whole issue of Medicaid transformation is something that most of the Republicans are interested in on the health care side.”