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Published: 2022-05-26 18:00:00 Updated: 2022-05-26 18:26:12

Posted May 26, 2022 6:00 p.m. EDT Updated May 26, 2022 6:26 p.m. EDT

By Travis Fain, WRAL state government reporter

The sudden emergence this week of legislation to expand Medicaid in North Carolina—but only if it’s paired with a similarly massive overhaul of state hospital and other industry regulations—has touched off an intense, behind-the-scenes fight at the North Carolina statehouse.

House Bill 149 moved quickly through the state Senate’s health care committee Thursday, without opposition from lobbyists. But in one-on-one meetings with lawmakers, multiple industry groups are working against the bill or weighing options that may ultimately turn them against the measure, even though it includes billions of dollars in federal Medicaid funding that they’ve wanted for years.

That means some parties might have to take the good with the bad. Michelle Laws, a spokeswoman for the North Carolina Medical Society, compared House Bill 149 to the dream home you can finally afford, except now there’s a sex offender living next door.

The medical society, which represents doctors at the legislature, is dead-set against a section of the bill that would lift restrictions on nurses and let them provide more services without a doctor’s supervision. Nurses pushed this change for years, and a bipartisan coalition of lawmakers says it’s a common sense way to expand health care access in the state.

The group says the proposal substitutes nurses for doctors in too many cases.

“You’re going to set up situations where … the only care poor people are going to be able to get is care that doesn’t include a physician who has so many more years of training,” Laws said.

She said the language looks like a poison pill in the Medicaid bill. “Political chicanery,” Laws said. “Why would you put that in there if you really want Medicaid expansion?”

Republican Sen. Joyce Krawiec, a bill sponsor, said Thursday that Medicaid expansion has to be paired with regulatory changes that increase care options, helping to absorb the hundreds of thousands of people newly eligible for health insurance under Medicaid expansion.

“There are going to be some things in this bill that folks are not going to like,” Krawiec said. “But it’s a package. … We do not want to expand Medicaid without improving the access, because we can’t take care of those people [otherwise.] And all of these things will take care of those people.”

The bill also includes a rollback in the complex state rules that limit the proliferation of hospitals and other health care services. To build a new facility, and in many cases to expand one, health care groups have to prove those expansions are needed through the so-called certificate-of-need process.

The bill ends many of those requirements and softens others, something conservative lawmakers have wanted for years and hospitals have fought tooth and nail. Now that it’s paired with Medicaid expansion, hospitals have a dilemma.

Industry executives said Thursday that they’re still digesting the bill, which also includes complicated changes to the way hospitals are taxed to raise money to help pay for Medicaid expansion. The North Carolina Healthcare Association, which lobbies for hospitals in the state, said it is “agnostic” on the bill for now.

“It’s a 33-page bill with a lot of moving parts and a sophisticated financing structure that we need to thoroughly review and discuss with our members before taking a position,” NCHA spokeswoman Cynthia Charles said in an email.

The bill was released Wednesday morning, and health industry lobbyists said they didn’t see the language until then. Rumors and media coverage indicating it was coming kicked lobbying efforts into gear before then, though.

Tim Rogers, head of an association for home health care and hospice companies, told his board in an email this week that, before the bill was released, he spoke with the head of the hospital association, as well as the Medical Society and an association for nursing homes in the state, to coordinate “a strong, unified message to legislators that this bill with the [certificate of need] provisions would be toxic to the North Carolina health system.”

Rogers said the bill was drafted without industry input, and he asked board members to contact lawmakers.

“While we appreciate and applaud the legislators for trying to address some important issues in healthcare, this bill is not the solution,and we ask them to vote against HB 149,” Rogers wrote.

Krawiec, R-Forsyth, said most of the lobbying against the bill so far has focused on the nursing language, which is known as the SAVE Act at the legislature, and not the certificate-of-need rollback, at least so far.

The bill is expected to pass the Senate as early as next week, but it faces opposition in the House from that chamber’s Republican majority.

Speaker of the House Tim Moore has said repeatedly that the measure won’t pass this year, and his office reiterated that Thursday.

But Senate Republicans hope to put pressure on Moore, and may use the state budget as leverage, in a strong-arm effort that plays out most years behind the scenes at the General Assembly.

Some GOP senators believe there are enough votes to pass this bill in the House Republican caucus, if only Moore will bring the bill to the House floor.

“If they believe that, they’re completely wrong,” House Majority Leader John Bell told WRAL News.

Bell, R-Wayne, said the bill will be “dead on arrival” in the House.

House lawmakers were surprised by the bill, Bell said. An agreement was reached last year to create a joint House-Senate committee to study Medicaid expansion and other health care issues and have a discussion on legislation once that committee wrapped up its work. The Senate jumped the gun.

“We were going through the committee process like we agreed to,” Bell said. “Then to have a bill come out of left field? … To have three very controversial subjects in it?

“There is strong opposition to the way the Senate has done that in our caucus,” Bell said. “Very strong opposition.”

Republican senators may stick the bill in the state budget, paired with a tax cut to entice GOP House members hesitant about supporting an expansion of government-run health insurance. That decision has not been made, but it’s an option.

Krawiec, who chairs the Senate Health Committee, said all the proposals in this bill have been discussed, repeatedly, during previous legislative sessions. “We just decided the Senate had to take the leadership role … if it was ever going to happen,” she said.

Gov. Roy Cooper will also be part of these conversations. Medicaid expansion has been one of his top priorities, but he has opposed Republican tax cuts. And Republicans don’t have enough votes to pass legislation over his veto without help from Cooper’s fellow Democrats.

So far Cooper hasn’t given the bill a thumbs up or down.

“Gov. Cooper is encouraged to see progress on getting more people covered with health care in North Carolina and will carefully review this legislation,” a spokesman for the governor said Thursday.

WRAL anchor/reporter Adam Owens contributed to this report.

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