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- The bill would also deregulate nursing and some medical services.
- But the legislation is unlikely to pass the N.C. House of Representatives this year.
Republicans in the North Carolina Senate are rushing this spring to do what was once an unthinkable heresy among most GOP lawmakers in this state: Allow an additional 500,000 to 600,000 lower-income residents to enroll in the Medicaid government healthcare program.
In other words: GOP Senate leaders said they will accept Medicaid expansion. This is a portion of the Affordable Care Act, aka “Obamacare,” that Republican lawmakers have nearly unanimously blocked in North Carolina since early 2013. They argued that the Medicaid expansion plan would be an expensive, unacceptable expansion of welfare.
The bill to expand Medicaid is H149, Expanding Access to Healthcare. And it would do a lot more than expand Medicaid. It would make other major and controversial changes to North Carolina’s health care industry as part of a broader effort that the sponsors say would make it easier and less expensive for everyone across the state to get treatment.
This bill could bring North Carolina its biggest changes to its health care industry since the Obamacare health insurance marketplace became active in late 2013 and brought subsidized health insurance to people who couldn’t afford to pay the full costs.
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But some of the people who have clamored since 2013 for Medicaid expansion oppose the other changes in the proposed act that would deregulate aspects of the health care industry, such as supervision of nurses and where medical services may be built, asserting they would be bad for the public.
Meanwhile, others who oppose Medicaid expansion are being asked to accept the expansion along with the deregulation they have long championed.
The bill is scheduled for a vote on the Senate floor on Wednesday. It next moves to the Republican-controlled state House. But there, the House speaker has told The Associated Press it will not be considered during the 2022 “short session” of lawmaking, which is expected to end around July 1.
In that case, the issue is unlikely to come up again until early next year.
What exactly would this Expanding Access to Healthcare bill do? And what makes it controversial?
Read on.
Health insurance for people who earn $18,075 or less
The Expanding Access to Healthcare bill would adjust the eligibility requirements for Medicaid so that an estimated 500,000 to 600,000 additional adults could use it for their health insurance. This is in addition to the 2.7 million adults and children in North Carolina who already use Medicaid.
The current standard prohibits childless adults from getting Medicaid.
The new standard would allow an individual with an annual income of up to 133% of the federal poverty level to get Medicaid for health insurance. In 2022, 133% of the federal poverty level is $18,075.
The act includes a work requirement for the new enrollees, but it’s uncertain whether North Carolina will be allowed by the federal courts to enforce that requirement. Regardless, the bill sponsors say most of the 500,000-plus potential enrollees are already working, but their employers aren’t providing them with insurance and with their low wages, they can’t afford to buy it themselves.
End some certificates of need — make it easier to open medical practices and services
The bill would deregulate the health care industry by doing away with some of the requirements for special state-issued licenses, called certificates of need, that are currently required before someone can open, offer or expand certain types of health services.
For example, if the state Department of Health and Human Services says a community already has enough magnetic resonance imaging machines then new MRI machines may not be brought into the area.
The state’s hospital association says this gatekeeping is important to protect community hospitals.
“For hospitals, the CON law prevents other providers from ‘cherry-picking’ the profitable services that allow hospitals to continue providing essential services to their communities,” the association, now called the N.C. Healthcare Association, said on its website in 2016. “Hospitals use the funds earned in excess of cost in one service line to subsidize other services, like emergency care, that are reimbursed at less than cost to preserve community access to care.”
Free market advocates, such as the John Locke Foundation think tank in Raleigh, assert that certificates of need limit access to health care, hurt services and boost prices.
If the Expanding Access to Healthcare bill passes, then certificates of need would no longer be required for air ambulances, emergency rooms, adult care homes, nursing homes, some homes for people with intellectual disabilities, for linear accelerators, gamma knives, or positron emission tomography scanners.
If you free the nurses, does that risk the patients?
A piece of The Expanding Access to Healthcare bill includes the “SAVE Act,” legislation to allow advanced practice registered nurses to provide medical services without the supervision of a physician.
Advanced practice nurses have advanced education and particular specialties.
The goal of this legislation is to get more nurses on the ground to bring care to underserved areas.
The North Carolina Medical Society, which represents physicians, while the North Carolina Nurses Association supports it.
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Executive Vice President and CEO Chip Baggett of the Medical Society said the nurses need supervision of physicians who are aware of the extent of the nurses’ training and skills to ensure patients are getting the care they need. He asserted that states that have done away with this supervision have not seen costs go down significantly.
Meka Douthit EL, president of the North Carolina Nurses Association, said in practice the nurses often get little real supervision from the physicians who oversee them, and some nurses have to pay for this oversight. She said the nurses are well-trained and would still be able to consult physicians as needed as they treat their patients.
Medical billing transparency
Another piece of The Expanding Access to Healthcare bill would require health care providers to warn patients ahead of time that even if they visit a hospital, clinic or other provider that is “in-network” under their health insurance, some of the services or staff might be “out-of-network.”
The provider would have to provide an estimate of the cost to the patient.
This provision is in response to patients getting unexpectedly high bills even when they try to stick within their insurance company’s network.
The Medical Society has concerns about this provision, Baggett said.
“We’d like to see an end to surprise billing also,” he said, but doctors worry that when they see the cost, some patients may forgo care that they need. The Society wants to work with the legislature to find another solution to surprise billing, he said.
Senior North Carolina reporter Paul Woolverton can be reached at 910-261-4710 and pwoolverton@gannett.com.
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