North Carolina Hospital Association exerted influence in Medicaid expansion negotiations

In the closing hours of the North Carolina legislative session, the state’s Republican leaders were poised to strike a deal to expand Medicaid and bring health care coverage to hundreds of thousands of the state’s poor. .

  • With bipartisan support, the Senate had passed an expansion version.
  • The House adopted another version.
  • All they had to do was negotiate.

As time ran out, lobbyists hovered outside leaders’ offices as chambers sent proposals back and forth. Observers whispered that the leaders were closer than ever to striking a deal once and for all.

Yes, but: The deal fell apart.

What happened: Republicans and Democrats tell Axios that one of the drivers of our state’s latest Medicaid failure is a group that represents the state’s hospitals: North Carolina’s Healthcare Association.

  • The association has fought to block the Senate plan, which would have expanded Medicaid as early as next year, in part because it would relax state laws on “certificates of need” – which, according to the association, would be a blow to hospital revenues.
  • Republican Senate Leader Phil Berger argued his inclusion was necessary to expand access to health care in the state.

Hospitals have won, so far. Neither bill advanced because, despite the Senate’s offer to relax the regulatory change, hospitals would only support the House plan, which omitted the change altogether.

  • “The House of Representatives has no intention of moving [the Senate’s bill] nor an appetite for changes to the CON law,” wrote Steve Lawler, who leads the hospital association, in a June letter to its members. undermine our support in the House. »

Why is this important: Berger has long been the biggest obstacle to Medicaid expansion until he quietly reversed his position and introduced legislation this year. That the hospital association is at the center of the latest failed legislation reveals a new challenge and underscores the far-reaching influence it has on North Carolina lawmakers and the legislative process.

  • “Hospital leaders know no vote will come on expanding Medicaid this year unless they undermine competition, but the powerful hospital lobby has not backed down out of fear for their profits,” he said. Gov. Roy Cooper said in an op-ed earlier this month, referring to the association’s blocking of regulatory change under the Senate plan.

The other side: Lawler disagrees that the organization is at fault.

  • In an interview with Axios last week, Lawler said the association was “not involved in the legislative process” and was supportive of the expansion, but thought the Senate bill was “harmful. ” and “unacceptable”.
  • Changes to the Certificate of Need, which limit unnecessary duplication of medical facilities, were the main reason the association opposed the Senate bill. North Carolina has one of the strictest certificate of need laws. Changing it could lower health care prices and increase health care facilities, proponents say.
  • “Expanding Medicaid should not come with terms that jeopardize the future of hospitals, our state’s safety net,” Lawler wrote in a letter to Cooper, Berger and Moore earlier this month. “We are not elected and therefore we are not the ones who oppose passing laws.”
  • House leaders also dispute that hospitals were at the heart of the proposal’s demise, saying the deal ultimately fell through because the two houses could not reach an agreement.

State of play: Medicaid expansion still has a chance of becoming law in North Carolina.

  • Political leaders and the hospital association say discussions are underway and they want the policy to be enacted or for the legislature to at least vote on a proposal.

The context: The Affordable Care Act of 2010 offered states the ability to expand coverage to people up to 138% of the federal poverty level, or about $38,000 a year for a family of four.

  • North Carolina remains one of 12 states that have yet to expand Medicaid since the program began in 2014.

The big picture: North Carolina is at the forefront of a new movement among Republican states where the political winds on the issue are changing.

  • In Georgia, as first reported by Emma Hurt of Axios Atlantanew conversations about the way forward have been happening behind the scenes between Democrats and Republicans.
  • The change doesn’t stop there: A former governor of Alabama publicly urged fellow Republicans to embrace it for the benefit of rural parts of the state. The bipartisan legislative movement on expansion this year has given Wyoming advocates hope. Texas sees “cracks” in Republican opposition to the measure, and Tennessee’s lieutenant governor has suggested a possible opening.

And after: House Speaker Tim Moore said he wanted to be sure hospitals agreed to change the main reason for their opposition to the Senate plan – the certificate of need – before his chamber voted, in another sign of hospital influence, the Associated Press reported.

  • Moore indicated a proposal could be worked out before the end of the year, and Berger said he was optimistic it could happen in next year’s legislative session.
  • “There’s still a window to do something,” Berger said. “But quite frankly, as long as hospitals remain as intransigent as they are, I don’t see if we’re going to make any progress.”

What we are looking at: “Neither the House nor the Senate could come to an agreement, and then they went home, but they went home knowing that the hospital community might come back with a proposal,” Lawler told Axios. “They will move the process forward, so once we have taken over the leadership of our proposal – it is not us who, again, tell the Senate and the House what to do.

  • “Then it’s up to our elected officials to get across the finish line,” Lawler said.

What they say : Republican State Treasurer Dale Folwell, who has repeatedly described the hospitals as a ‘cartel’, told Axios that ‘facts don’t matter’ to Lawler, as ‘this latest data shows. on expanding Medicaid. Folwell pointed to the Senate plan as a step in the right direction.

  • “If you’re in favor of Medicaid expansion, you should be very angry with Steve Lawler,” Folwell said. “If you’re against Medicaid expansion, you should be very angry with Steve Lawler.”

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