Governor’s Council Recommends Expanding Access to Health Care Coverage

The concept of expanding Medicaid has been met with fierce debate in North Carolina—even to the point of causing a budget impasse between the Governor and the NC General Assembly.  The NC Council for Health Care Coverage was a bipartisan, diverse group of legislative, business and State government leaders convened by Governor Cooper to discuss Medicaid expansion and other options for increasing access to health care coverage.  This short-term group met four times between December and January and developed guiding principles.  Governor Cooper stated in his closing remarks at their last meeting, “I think we ought to keep these principles ahead of us as a roadmap…I look forward to working with legislative leaders to build on this momentum.”  The last meeting of the Council occurred just before the NC General Assembly really began the Long Session on January 27^th. 

The 2019 Census American Community Survey results show that North Carolina has the sixth highest uninsured rate in the country.  Some other statistics considered by the Council members included:

• 44% of individuals who are uninsured hold full-time jobs
• 28% of workers do not have access to employer medical coverage and many of those individuals are in the service industry, lower on the pay scale and work in small businesses
• Individuals living in rural areas of North Carolina have a 40% higher chance of being uninsured
• North Carolina hospitals provided $1.825 billion in uncompensated care in 2019

Over the course of their meetings, Council members considered several potential solutions to reduce the number of uninsured North Carolinians:

• Individual Market Reinsurance Program
• Association Health Plans
• Small Business Tax Credit
• Full Medicaid Expansion
• Partial Medicaid Expansion
• Medicaid coverage extension for pregnant women to 12 months postpartum
• Medicaid coverage extension for parents of children in foster care

They wrapped up their work by agreeing on a set of principles that should be considered as a part of future discussions about the gap in health insurance coverage in our State.  Some of those principles are that coverage options should:

• Expand access to and coverage of behavioral health services, including access through parity in coverage
• Increase affordable health insurance coverage, ensure program simplicity and support small businesses that struggle to provide coverage for their employees
• Improve the health status of the population and ensure health care insurance programs are sustainable with efficient use of taxpayer dollars
• Strengthen rural communities and reduce disparities in access to health care

The Council also identified other strategies to increase access to health care coverage by lowering the cost of care, strengthening telehealth, enhancing network adequacy, focusing on workforce development, increasing access to primary care, considering non-medical drivers of health and focusing on preventive services like vision and dental. 

Legislative leaders have indicated that full Medicaid expansion is not likely to be discussed in this Long Session but also indicated the potential of considering other options that increase access to health care coverage.