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Trying Again: Cooper Seeks Coverage For North Carolina's 1.2 Million Uninsured

Governor Roy Cooper

Gov. Roy Cooper’s efforts to convince Republican legislators to expand Medicaid for North Carolina’s 1.2 million uninsured continued Friday but, judging by initial comments, legislators remain unimpressed.

Cooper’s previous efforts to expand Medicaid coverage for those earning up to 138% of the poverty level ran into Republican opposition, resulting in a stalemate over the state budget. Now that voters have returned both Cooper and Republican legislative majorities to Raleigh, Cooper is hoping to build a consensus to improve health care access.

He invited three dozen health care executives, business leaders and legislators to join his newly created North Carolina Council on Health Care Coverage, and told the group’s first meeting he wasn’t endorsing any specific policies.

But in several presentations today, experts presented data supporting the case for Medicaid expansion, much to the disappointment of some of the Republican members.

Dr. Mark Holmes, a rural health expert at the Duke-Margolis Center for Health Policy, explained that expansion would benefit 34% of North Carolina’s, including from 8 to 13% of the population in the Duplin- Robeson-Bladen county area.

He also made the case that three-quarters of those who would benefit are currently employed, including roughly half of the state’s small business employees, 20% of child day care workers, and 14% of those who work in nursing homes. Holmes also said expansion will benefit hospitals, which wrote off $1.8 billion of uncompensated care in 2019, and is especially important to rural hospitals now at “high financial risk.”

The Council also heard how expansion benefitted Ohio under Republican Gov. John Kasich. Greg Moody, who headed the expansion effort there, said it improved health outcomes, stabilized the health system and enabled the state to put $2 billion into its rainy-day fund.

Presenters were clearly hoping the information would help to melt partisan opposition to expansion; eight of the 12 invited legislators are Republican. But at the end, the only ones to comment, said they were disappointed by the focus on Medicaid expansion, and hoped to hear about alternative ideas.

Sen. Joyce Krawiec, who chairs the Senate Health Care Committee, says she would like to discuss association health plans, which she said could benefit as many as 150,000 people, although she admitted the idea is stalled in federal court. Her reservations were echoed by Rep. Donny Lambeth, who has supported limited expansion proposals in the past. And Rep. Donna White expressed interest in efforts to reduce the regulatory burden on physicians.

The group has two more meetings scheduled for later this month, during which time North Carolina’s Secretary for Health and Human Services has promised to address Republican legislators’ concerns.

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Dana Miller Ervin is a reporter at WFAE, examining the U.S. health care system.