State Rep. Jon Hardister has lost enthusiasm for a Republican-led compromise he co-sponsored to expand Medicaid coverage for lower-income residents.
The Republican legislator from Whitsett said he no longer supports the measure largely out of concern that if it becomes law, it could get tied up in a costly court battle over requirements that able-bodied recipients hold jobs and pay relatively small premiums.
“I’m a ‘No’ at this point given the current composition of the bill,” Hardister said. “I’ve had quite a lot of feedback on both sides of the issue.”
Though no longer a supporter, Hardister continues to be listed among the bill’s co-sponsors, including 14 Republican and four Democratic state representatives. Three other Republican legislators, led by state Rep. Donny Lambeth of Winston-Salem, are primary sponsors.
The measure, House Bill 655, is an effort to reach middle ground with Gov. Roy Cooper and other Democrats who have made expanding the state Medicaid program a top legislative priority.
The two sides have been at loggerheads for months over the Medicaid issue, which was a factor in Cooper’s decision to veto the 2019-21 budget.
The GOP-inspired Medicaid measure originally introduced by Lambeth would extend the possibility of health coverage to an estimated 365,000 lower-income North Carolina residents who “are either not employed full-time or are not making enough money to afford health insurance coverage.”
“This bill is well-intentioned and it is worth considering,” Hardister said via email. “While this bill has work requirements and premium requirements for able-bodied adults, I fear that these requirements would get struck down in court.”
He said that he’s learned of “at least three other states that have expanded Medicaid with a work requirement, only to see those requirements tied up in litigation.”
Supporters of the bill say that while it’s not perfect, it would help a lot of people who really need a hand while benefiting the larger community as well.
“Getting affordable health coverage to low-income, uninsured people has been shown to reduce the cost of health care across the board, including for people who are privately insured,” said Rob Thompson, deputy director of the nonprofit group NC Child that advocates for policies and programs helping the state’s youth.
Thompson’s group recently distributed a news release touting Hardister as “a pivotal vote” on the bill that’s known formally as “NC Health Care for Working Families.”
Upon learning Wednesday that Hardister had changed his position, Thompson said that was unfortunate but added he still hopes there is enough support among GOP legislators to push the bill through the 120-seat state House, which has 65 Republicans and 55 Democrats.
Hardister said in reassessing the measure, he believes, among other things, that North Carolina should develop programs that focus more intensely on treatment for mental disorders and substance-abuse recovery.
“Some states that have expanded Medicaid have experienced cost overruns and enrollment that exceeded projections,” Hardister said. “This makes it hard to predict and control costs.”
Recent research supported by Cone Health Foundation found that in Guilford County, an expanded Medicaid program would make more than 35,000 people newly eligible for health coverage.
That research by the Milken Institute at George Washington University projected that Medicaid expansion would create 2,700 jobs in Guilford within three years, pump about $683 million into the local economy and boost county tax revenue by $7.6 million from 2020 to 2022.
As it stands now in North Carolina, adult Medicaid recipients must either have a qualifying disability or be a parent with children at home earning below 44 percent of the federal poverty level — or less than $1,000 per month for a family of four.
If the bill becomes law, North Carolina would join 37 other states that have extended Medicaid coverage. It would provide coverage to those earning a monthly income of about $2,850 for a four-person family.
The federal government then would pay 90 percent of the additional cost, with the remainder covered through an assessment paid by the state’s health systems. Those health systems would benefit from the expansion by serving more patients who can pay their medical bills.
State Rep. John Faircloth of High Point, who also signed onto the bill as a Republican co-sponsor, said Wednesday that he remains a supporter.
“I think the greatest value that I hoped for was that it would bring people to the table and stop throwing rocks at each other,” Faircloth said of the contentious atmosphere in Raleigh.
He added that everyone can agree “there’s a void out there for a large number of people who need good health care and simply cannot afford it.”
Democrats say they would prefer a “clean” Medicaid expansion that offered lower wage earners access to coverage without work requirements or demands that they pay premiums.
State Rep. Pricey Harrison, D-Greensboro, said the bill’s work requirements and enforced premiums are just extra baggage that do not serve a useful purpose.
“Most people who need this already are working,” she said, noting that enforcing work and a premium mandate likely would cost more than any savings or added revenue it might produce.
But she and many fellow Democrats, including state Rep. Amos Quick of Greensboro, still support the GOP initiative as at least a step in what they would call the right direction.
“My first, second and third choice is a clean Medicaid expansion. So it’s not preferable or optimal,” Quick said of the GOP version. “But if it’s the choice we have to make, then I would be inclined to support something rather than nothing.”
He, Harrison and many other Democrats had sponsored a competing bill earlier in the session that would have expanded Medicaid without any strings — a proposal that never made it out of committee.