Senate leader: NC hospitals' Medicaid proposal not 'serious'

North Carolina Senate leader Phil Berger on Tuesday called an offer from state hospitals to expand Medicaid to hundreds of thousands of the working poor “not a serious proposal,” saying loosened regulations for medical construction projects didn't go far enough.

Berger's dismissal of the proposal late last week from the North Carolina Healthcare Association short-circuited any expectations — though much improved compared to months ago — that a Medicaid expansion agreement could be at hand. Still, Democratic Gov. Roy Cooper, an expansion advocate, urged Berger separately Tuesday to make a counteroffer.

Expansion also would create an influx of several billion dollars from the federal government that the state is missing out on, Cooper added. North Carolina is one of a dozen states that haven't accepted the federal government’s Medicaid offer originating from the 2010 health care law.

"When we have lives at stake, ... we don’t have any time to lose,” Cooper said at an Executive Mansion event unrelated to Medicaid. “Whatever it takes, we have to be all in on this.”

The House and Senate passed competing expansion proposals in June, and the next month Berger and House Speaker Tim Moore expressed their commitment to work together for the initiative.

Senate Republicans insist any final agreement must contain provisions to increase the supply of medical services to handle the additional patients that Medicaid would bring. Chief on their list is scaling back and streamlining “certificate of need” laws that require health regulators to sign off on expansion plans by medical providers.

Berger had complained in recent months that the North Carolina Healthcare Association, a lobbying group for over 130 hospitals, health systems and other groups, wouldn't accept a significant pullback of certificate of need laws.

The association's offer, which came a few days after Cooper urged the hospitals to engage with Berger, would do away with such laws for psychiatric inpatient beds and beds to treat people with chemical dependency. Within five years, it also would scale back regulations for operating rooms in ambulatory surgical centers.

Although Berger recognized the association's willingness to move on the issue, he criticized the form and the substance in a Legislative Building news conference.

Berger said the association's offer looked “like it was more to deal public relations than a substantive or a serious proposal." And he said the ambulatory surgical center rule changes would appear to make it so the only entities that could open such a center would be another hospital.

“It looks to me like it’s more designed to further entrench the monopolies that the hospitals have,” Berger said.

An association leader has said its offer was “an effort to get stalled negotiations moving” and the ambulatory surgical center changes alone would result in at least $700 million less revenue.

Berger didn't say specifically whether Senate Republicans would make a counteroffer, adding that the Republican-controlled House, the governor and the hospitals know their certificate of need position and that senators previously sent “several alternatives" to the House. He wouldn't provide further specifics.

The Medicaid bill passed by the House in late June directed Cooper’s administration to develop an expansion plan by mid-December — after which legislators would take an up or down vote on it. The legislation left out supply-side medical reforms like certificate of need. In July, Moore called the Senate version a “nonstarter.”

When the legislature's primary work session ended July 1, legislative leaders scheduled monthly three-day sessions, including one that began Tuesday, to take up any urgent matters — or potentially an expansion agreement. Like the previous two monthly meetings, this week's session also will have no recorded votes.

If action isn't taken by year's end, Medicaid expansion efforts would reset as a new edition of the 170-member General Assembly is seated in January.