Health council creates ‘principles’ for expanded health insurance coverage in NC

The NC Council for Health Care Coverage worked Friday to put the final touches on a set of principles that it hopes will guide legislators and the Cooper administration toward getting health insurance for more North Carolinians.

The large group of lawmakers, employers, insurers and others have met under the auspices of the Duke-Margolis Center for Health Policy since last month to come up with goals for expanded health insurance coverage.

Gov. Roy Cooper, a Democrat, created the bipartisan group. He pushed for Medicaid expansion in his first term as the way to get more adults insured. Opponents in the Republican-controlled legislature  have said they worry about costs to the state. Medicaid expansion has never come to a vote. The federal government pays 90% of Medicaid expansion costs.

According to the Census Bureau American Community Survey data, 46% of North Carolinians got health coverage through employers, 18% used Medicaid, 15% used Medicare, 12% were uninsured, 7% were paying for insurance through the individual market, and 2% were insured through the military in 2019.

On Friday, at the council’s last meeting, Cooper called the principles “truly bipartisan,” reflecting a range of perspectives.

Cooper said he remains a strong supporter of Medicaid expansion. “This council has demonstrated there are many ideas and perspectives and proposals that need to be considered as we look to solutions that are right for our state,” he said. “The pandemic has exposed a lot of these challenges that we are already facing and it has magnified those challenges.

The Council on Friday worked to refine its draft principles, which are:

  • Maximize health care coverage
  • Program simplicity
  • Enhance the health of North Carolina
  • Efficient use of tax dollars
  • Strengthen rural communities
  • Reduce disparities by geography, race, and ethnicity
  • Expand access to and coverage of behavioral health services
  • Support the business community, both for profit and non-profit

Some Council members Friday said they didn’t want Medicaid expansion to get lost in the stack of other ideas. Others emphasized help for small businesses.

Nearly all North Carolina businesses with 1,000 or more workers offer health insurance, according to information the state Department of Health and Human Services presented at a meeting earlier this month. About half of businesses with 10-24 workers offer health insurance as an employee benefit, while 15.3% of businesses with fewer than 10 employees offer health insurance.

Rep. Carla Cunningham, a Charlotte Democrat, said it was expensive to pay a living wage and offer health insurance when she ran a small business.

Andy Ellen, president of the NC Retail Merchants Association, said small businesses are in competing for workers with larger businesses who offer health insurance with lower premiums.

Sen. Mike Woodard, a Durham Democrat, said unaffordable insurance affects Durham tech startups and small rural businesses.

“It’s hurting small business and it’s hurting entrepreneurship,” Woodard said.

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