Cooper Pushes For Medicaid Expansion At Rural Hospital Forum

North Carolina Gov. Roy Cooper used a round-table discussion with rural hospital executives Wednesday to raise pressure on Republican lawmakers to expand Medicaid coverage to more uninsured adults.

Executives from seven hospitals met with the Democratic governor and expressed support for offering Medicaid to more uninsured adults who can't otherwise qualify because they make too much money. They said the expansion would help them reduce the cost their hospitals bear for uncompensated care.

A bill filed this month by some House Republicans would require recipients of the expanded benefit to pay premiums and meet some work requirements. A similar bill was proposed in 2017, but failed amid GOP opposition.

Cooper expressed reservations about the bill's work requirements, but said he wants to work with legislators to hammer out specifics of Medicaid expansion.

"Let's concentrate on this expansion that will be positive for everyone. We know this will increase the bottom line so that rural hospitals can hire more doctors and nurses, so that health care premiums for everyone can be affected, so that jobs can be created," Cooper said. "Then, we negotiate those other issues."

Expanding Medicaid has long been a goal of Cooper's. This session he has more leverage to negotiate after Democrats broke veto-proof majorities in both houses of the General Assembly last fall.

But any expansion would face an uphill battle. While some House Republicans support expansion, Cooper's greatest challenge is drum up support from Senate Republicans, who strongly oppose the idea.

If the bill introduced by House Republicans passes, the federal government would pay 90% of the cost of Medicaid expansion and the state would cover the other 10% through assessments, or taxes on hospitals and other health care providers. At Wednesday's discussion, Lee Isley, the CEO for Nash UNC Health Care, said that if North Carolina chooses to expand Medicaid, he wants to see the state's 10% cost shared among hospitals and health insurance companies.

"All we're asking is a fair distribution for providers to be able to share in the cost so that we can all share in the benefit," Isley said.

Five hospitals submitted resoltions to the governor's office at the event, urging the General Assembly to expand Medicaid in North Carolina as soon as possible.

At stake is the ability for rural hospitals to survive. Since 2010, dozens of rural hospitals have closed in the U.S. Four were in North Carolina.

"Last year we had $17 million worth of uncompensated care, so not quite a third ... of our business is uncompensated," said Erlanger Western Carolina Hospital CEO Mark Kimball. "Every month we start in the hole a million and half dollars, and that's tremendous, and with this expansion of Medicaid, that could help us tremendously."

Part of this debt is due to a high volume of emergency room patients, many of whom are uninsured.

Last year, Isley said his hospital lost about $25 million. He said Nash UNC Health Care, which serves roughly 150,000 people, sees about 70,000 emergency visits a year, which he called "a high percent."

The hospital executives said a lack of primary care physicians within their communities serves to increase emergency room visits for untreated chronic health issues.

"In our region, we've got a growing doctor desert," said Cape Fear Valley Hospital CEO Michael Nagowski. "In Harnett county, we have two OB-GYNs and one just told me he's retiring."

To address this, the bill filed by House Republicans would also set up a rural health grant program that would put millions of dollars toward recruiting and retaining doctors and expanding health services.

However, Senate Republicans dispute claims that Medicaid expansion would benefit the state. Senate leader Phil Berger was not available for comment Wednesday, but his office referred to his previous statements arguing that taxpayers in the private insurance market will end up paying the price for Medicaid expansion.

"There is no such thing as 'free' money, someone always has to pay," Berger wrote in a March 11 statement.