Omnibus Healthcare Bill
Through a newly unveiled senate bill, North Carolina could be the 40th state to expand Medicaid, the 25th state to approve full practice authority for advanced practice nurse practitioners (APRNs), and the ninth state to enact comprehensive telehealth policies. House Bill 149: Expanding Access to Healthcare would also relax many of the state’s Certificate of Need (CON) laws and expand access to telehealth services. Senate President Pro Tempore Phil Berger (R-Rockingham) joined five other Republican Senators to introduce the legislation during a Tuesday press conference before advancing the bill through several committees this week.
Under the Affordable Care Act, states can adopt the expansion of Medicaid to provide healthcare coverage to individuals making incomes up to 138% of the federal poverty level. This includes around 600,000 North Carolinians who fall into the coverage gap, meaning they work and make too much money to qualify for Medicaid currently, but cannot afford to have private insurance. The Senate's version of HB 149 includes a work requirement, which could lead to future controversy since similar work requirements have been repeatedly struck down in other states by federal judges. The Affordable Care Act requires the federal government to cover 90% of the cost for a state’s share of additional Medicaid enrollees, with the state covering the remaining 10%. The Senate’s bill would pay for most of the state's 10% share by implementing an additional hospital assessment.
Another reform in the bill would make it possible for APRNs like nurse practitioners, certified nurse midwives, clinical nurse specialists, and certified registered nurse anesthetists to practice without being under direct supervision of a physician. Sen. Joyce Krawiec (R-Forsyth), a sponsor of the bill, noted in committee that 34 other states have already adopted similar rules around the practice of nursing. Opponents of the provision raised concerns over the education received by APRNs compared to that of physicians and anesthesiologists.
The bill also revises the state’s complex rules that limit the ability of hospitals and health care service providers to construct new facilities. Currently in North Carolina, CON laws require providers to prove that expansions are needed. The legislation would end many of the requirements for specific types of facilities that require a CON review by the Department of Health and Human Services (DHHS). Additionally, the bill would expand the usage of telehealth by developing statewide standards and implementation guidelines.
The legislation passed the Senate Health Care and Finance committees by voice vote and will make its way to the Senate Rules committee next week. However, the bill still has a long way to go. House Speaker Tim Moore (R-Cleveland) told reporters Wednesday afternoon that he did not think members of his own caucus had the appetite for Medicaid expansion during this summer's short session.