Support was nearly unanimous in the chamber for the measure, which also loosens practice restrictions on specialty nurses and eases government scrutiny of medical construction and equipment.
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The bill's anchor - Medicaid expansion - represents a dramatic turn for its prospects in North Carolina after being blocked for a decade by GOP elected officials.
Still, House Republicans aren't interested in considering expansion during the annual work session expected to end around July 1, Speaker Tim Moore said recently, potentially leaving the issue for the fall or 2023. A final Senate vote is expected Thursday before the bill moves to the House.
Senate leader Phil Berger and other Republicans had been adamantly opposed to adding adults to the Medicaid rolls through the 2010 Affordable Care Act. They had argued the state Medicaid program was broken and Washington couldn't be trusted to keep paying 90% of the costs for insuring adults who otherwise made too much to received traditional Medicaid. North Carolina is one of a dozen states that hasn't yet accepted expansion.
But Berger said last fall he was willing to consider expanding Medicaid as part of budget negotiations. Now he says that the state's Medicaid program is fiscally sound and Congress probably won't lower the federal government's 90% share. North Carolina also would receive an additional $1.5 billion over two years to treat traditional Medicaid patients if it signs up.
"Medicaid expansion has evolved to the point that it's good state fiscal policy," said Sen. Ralph Hise, a Mitchell County Republican, said on the Senate floor before the vote of 44-2. "We will not get a better deal to expand Medicaid than we have right now."
Last week, Berger, Hise and others unveiled expansion within a multipronged effort that includes several other health care reforms that they say will help increase the number of providers and services in rural areas. Provisions that would allow nurse practitioners, nurse anesthetists and others to practice independently without a physician's supervision are opposed by the state's leading doctors association.
Democrats led by Gov. Roy Cooper have sought expansion for years, and senators in his party, while taking issue with portions of the broader bill, praised Republicans for a "monumental" step.
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"It does my heart good that even though it took 10 years, y'all are there. Praise the Lord," said Sen. Gladys Robinson, a Guilford County Democrat. "Nothing is more important than a person's health."
The expansion proposal would likely cover 500,000 or 600,000 people whose income reaches up to 138% of federal poverty guidelines. Although about 2.7 million North Carolina residents are now enrolled in Medicaid, some current consumers whom the state has been required to keep on the rolls during the COVID-19 pandemic would ultimately be covered by expansion.
The state's 10% share of expansion expenses would be paid through a new assessment on hospitals. The "NC Health Works" program also would include a work requirement for expansion recipients. Similar mandates by other states have been struck down by federal courts or blocked by President Joe Biden's administration. Expansion would go forward even if a work mandate doesn't get approved by the Centers for Medicare and Medicaid Services.
The bill also would scale back and streamline "certificate of need" laws that require health regulators to sign off on expansion plans by medical providers. The legislation would require health insurers in the state to cover telehealth services. And in-network health facilities would have to alert patients before an appointment when out-of-network providers are scheduled to provide care.
The conservative John Locke Foundation and the state chapter of Americans for Prosperity opposed the legislation, saying that expansion would result in higher federal deficits, not better health care.
"For years, most state senators have rightfully recognized that Medicaid expansion is bad medicine for North Carolina," said Locke Foundation CEO Amy O. Cooke said in news release. "Their changed view is disappointing."