A coalition of 28 public health and advocacy groups is urging state health systems to prioritize Medicaid expansion over revenue protection in hopes of grease the wheels of the one of two bills in the state legislature.
Several analyzes have cited that between 450,000 and 650,000 North Carolinas could benefit from the Medicaid expansion.
The coalition sent a three-page letter Monday to Steve Lawler, president and CEO of the NC Healthcare Association.
The coalition wrote that “there have been trends and practices in our state’s hospitals and health care systems that raise alarm bells for advocates who share your vision for equitable health care.”
“We must call attention to the business practices under which hospitals operate, as they have devastating consequences for income inequality, the financial well-being of families and the overall health of communities.”
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Coalition members include the NC Justice Center, Black Workers for Justice, NC Poor People’s Campaign, NC Council for Women, NC Council of Churches, NC NAACP, and NC Pro-Choice.
The coalition expressed gratitude in its letter to Lawler for his recent NCHA letter to Democratic Gov. Roy Cooper and Republican legislative leaders asking for progress on Medicaid expansion.
The NCHA’s goal is to urge political leaders to reach a compromise by the end of the year on Senate Bill 408 and House Bill 149. The two revamped bills were approved by one house in June, but were not discussed in the other.
Several Triad lawmakers said it was possible a compromise could be reached by the mini-session scheduled for September.
“Over the past decade, the undersigned organizations have advocated tirelessly to increase access to affordable health care for more than 600,000 North Carolina residents by expanding Medicaid,” according to the coalition’s letter.
“We also recognize that hospitals have urged lawmakers to expand Medicaid.
“However, the NC Healthcare Association’s priority of protecting members’ incomes from expanding Medicaid — which benefits poorer North Carolinas — has halted the historic progress our state has made toward health care. fair.”
The NCHA responded to the coalition’s letter saying, “Expanding Medicaid has been a top priority for North Carolina hospitals since the opportunity first presented itself to the state.
“Regardless of the political party in power, our position has never changed.
The state’s major health systems and hospitals have agreed to pay — through an estimated annual assessment of $758 million — the 10% share of North Carolina’s administrative expenses resulting from the Medicaid expansion. The federal government pays the remaining 90%.
“Hospitals believe so strongly in the moral imperative of Medicaid expansion that they are willing to take on the full state share to pay for it,” the NCHA said.
However, the NCHA warned that “the math must work for hospitals to pay the more than $500 million a year of the cost, while keeping community hospital services available.”
The coalition said “we are concerned that hospitals are not providing adequate charitable care, billing collections and burdening families with medical debt while enjoying record profits in one of the most consolidated hospital markets. from the country”.
“During what the NC Healthcare Association has described as the ‘worst financial scenario of most of our careers,’ nearly every major hospital and health care system in our state saw record profits during the pandemic.”
Targeting the revenue stream of health care systems, the coalition joined State Treasurer Dale Folwell in challenging their priorities.
The back and forth between Folwell, the SHP, and major state health systems has at times proved tense and personal in nature.
The coalition cited as an example of its concerns about health systems priorities that “too many North Carolina people on a daily basis are saddled with medical debt, are dogged by collections, and will never be able to realize their dream of becoming owners, to buy a car, or to move forward in life because they got sick and couldn’t afford to pay.”
Folwell cited each of these concerns in his talking points that accuse nonprofit health care systems of prioritizing revenue over charitable care.
Folwell and the NC State Health Plan commissioned an analysis from the Johns Hopkins Bloomberg School of Public Health on how the state’s nonprofit hospitals — including the largest three in the Triad — assess whether they honor their charitable mission fully.
The state treasurer has oversight authority over the SHP, which has more than 727,000 participants, including current and retired state employees, teachers, and legislators. It is the largest purchaser of medical and pharmaceutical services in North Carolina.
The coalition wrote to Lawler that Johns Hopkins’ analysis shows “many hospitals across our state are failing in their financial obligations to taxpayers by not providing enough charitable care to their most financially vulnerable patients.”
Folwell said on Tuesday that “we are grateful that these organizations have finally become attentive to the reports that have been coming out of the treasurer’s office for almost a year.”
“We are grateful that the authors acknowledge that medical debt robs people of the joy of achievement and upward mobility.
“It’s time to stop punishing the sick by weaponizing their credit score for something they didn’t want to consume.”
Medicaid expansion bills
Both Berger and Moore said it was time to reach a compromise to expand Medicaid this year.
They also said it may take a compromise attempt in the 2023 session, which will have a different legislative makeup that may be more or less inclined to support House or Senate Medicaid expansion bills. .
Key elements of SB408 help preserve rural hospitals and call on DHHS to develop a Medicaid modernization and savings plan with a Dec. 15 deadline for filing a report with a legislative oversight committee joint.
“We need to know exactly what we’re getting” from Medicaid expansion, particularly in terms of expanding access to health care providers “in a cost-effective way,” Moore said, “That way , we have the certainty.. … and the last word.
If the Legislative Oversight Committee approves the plan in December, Moore had promised that SB408 would receive an up-and-down vote soon after.
Meanwhile, HB149 — in exchange for expanding Medicaid — contains several long-sought Senate Republican health care reforms, primarily weakening state certificate of need laws that appear to be a major hurdle in the House. .
The bill would also allow nurse practitioners, certified nurse midwives and other providers to work independently of doctors.
Berger said when introducing the revamped HB149 that “if there’s anyone in the state of North Carolina who’s spoken out against Medicaid expansion more than me, I’d like to meet that person. We need coverage in North Carolina for the working poor.
Lawler pointed out in his letter to Cooper, Berger, and Moore that NCHA members “are not elected and therefore we are not the ones who stand in the way of laws being passed. This burden and opportunity rests with your branches of government.
“Both options are essential as we continue to grow and prosper as a state. Both options are too important to leave out because you’re looking for a deal.
The coalition said “our preference is to have a bill that only expands Medicaid, and while SB408 is a step in the right direction, we believe SB408 is delaying health care even further unnecessarily.”
“SB408 does not guarantee that 600,000 North Carolina residents will get the health care they have been waiting for over the past decade.
“He offers to study and research Medicaid expansion again when we all know health care can’t wait.”