Adam Sotak: House Bill 655 could be good compromise for Medicaid expansion in North Carolina

Published 12:00 am Sunday, September 29, 2019

By Adam Sotak

On Tuesday night, Salisbury will be the site for an important public conversation about the issue of Medicaid expansion.

The forum, hosted by the N.C. Institute of Political Leadership, will be 7 p.m. in the Norvell Theater.

It’s an ideal setting given that thousands of Rowan County citizens are working full- or part-time yet have no health insurance coverage. N.C. Rural Center research shows there are over 8,000 workers in Rowan County who are at or below 125% of the federal poverty level. These are hard-working adults who often have two or three jobs. They serve us our food, take care of our young children, cut our grass and build and repair our homes. They are our parents, sons and daughters. They are the working poor.

The health insurance system is broken for these folks. Most of them make too much money to receive Medicaid and too little to get affordable insurance through the Affordable Care Act. If they lived in Virginia or 36 other states they would have an affordable health insurance option but not in North Carolina. Unfortunately, the question of extending health coverage in Rowan County and across our state has become far too partisan, not unlike so many other important issues of our time.

What we should be focusing on is the overwhelming health and economic benefits that come along with expanding health coverage. Look, for example, at the great strides we’ve made in the past 25 years related to children’s health outcomes in North Carolina and across the US — 95% of children are covered by insurance. Almost no one would suggest that we turn back to the days of only 70-75% of kids being covered.

While political compromise can be hard to find, there’s actually strong momentum for coverage gap legislation being considered in the NC General Assembly. A compromise bill (think of it as “Medicaid expansion-lite”) is on the move in the North Carolina House and has support from both Republicans and Democrats. House Bill 655, NC Health Care for Working Families Act, is sponsored by Rep. Donny Lambeth, a powerful Republican legislator and former hospital administrator from Forsyth County. The bill recently passed the House Health committee and is expected to be voted on by the full House in early October. The bill has over 20 Republican co-sponsors and dozens of Democrats who have also voiced their support.

Locally, the Rowan County Chamber of Commerce has endorsed H.B. 655 as a good solution to provide an insurance option for the working poor. Rowan’s Novant Health has also passed a resolution urging legislators to pass a solution to close the coverage gap. It is joining over 100 other prominent business leaders in North Carolina calling for a solution.

H.B. 655 would have no budget impact on North Carolina; 90% of the cost of the program would be covered by the federal government, with the remaining 10% paid for through assessments on health providers. If the federal “match rate” was ever changed by Congress to go below 90%, H.B. 655 has a provision that would automatically shut down the program in order to limit its potential impact on the state budget.

H.B. 655 also requires recipients to follow wellness guidelines (like attending regularly scheduled physicals), to pay small monthly premium payments (up to 2% of monthly income) and comply with a work reporting requirement.

While our organization has strong concerns about the barriers to coverage that work-reporting requirements and premium payments create for people (especially working parents), we see the greater good in this compromise that can insure so many.

Still not convinced? Look at the economics. North Carolina taxpayers have already sent over $8 billion of our tax money to the federal government in order to pay for expanded health coverage in other states. That’s money we are all paying and seeing absolutely no benefit from. A recent report by the Cone Health Foundation estimates that Rowan County would  gain 367 jobs and over $74 million in economic growth if N.C. to fully expand Medicaid.

While this issue continues to be debated, let’s keep the thousands of working uninsured people in mind and understand there’s a workable solution at our fingertips in the form of H.B. 655.

Adam Sotak is the public engagement director for N.C. Child in Raleigh and is a 1992 graduate of Salisbury High School.