NC Senate Republicans do a 180 on Medicaid expansion and offer their own proposal

Senate leader Phil Berger, Sr.

Senate Republicans, some formerly fierce opponents of Medicaid expansion, introduced their own expansion bill Wednesday that would give more than 500,000 low-income adults the chance to obtain health insurance.

The bill is packaged with other healthcare provisions that have legislative champions but have faced stiff opposition over the years, including allowing advanced practice registered nurses to work without doctors’ supervision, and changing the Certificate of Need law, under which the state determines whether a new medical facility or expensive piece of medical equipment is needed in an area.

The bill also addresses insurance payments for telehealth, which has emerged as a contentious issue as the immediate shock of the pandemic has faded.

Even as they introduced the bill, senators acknowledged it was unlikely to get through the state House in the short session. A legislative committee of House members and senators had been meeting since February to examine Medicaid expansion. That committee has suspended meetings during the legislative session, and the committee’s House co-chairman said last month he was anticipating more work when the session adjourns.

Senate leader Phil Berger, an Eden Republican, said Wednesday that the goal was to get the Medicaid expansion bill out of the Senate and to the House.

“This gives the committee, if we don’t get it passed in the short session, something else to chew on,” Berger said.

Senate Republican leaders had opposed Medicaid expansion for years. On Wednesday, some of them made a complete about-face, articulating the same points that longtime Medicaid expansion supporters have made for years.

Legislative Democrats and Democratic Gov. Roy Cooper have been longtime supporters of Medicaid expansion. At one time, a group of House Republicans worked on an expansion-like bill that Berger vowed would never get through the Senate.

That was all changed Wednesday. Berger even offered a vignette about a working single mother who could not afford health insurance as an example of a person Medicaid expansion would help.

Many of the low-income adults without health insurance have jobs, it would help more people obtain mental health care, and it would give people living in areas of the state with high incidences of life-threatening chronic diseases the chance at routine medical care.

About 2.7 million people in the state have Medicaid coverage. Most of them are children. The federal government pays more than two-thirds of Medicaid costs.

The state Medicaid program does not cover most adults who don’t have dependent children living at home. Parents with children must have extremely low incomes to qualify for Medicaid. That leaves most low-income adults in what’s called an insurance gap. They make too much to qualify for Medicaid, but too little to qualify for subsidized insurance in the marketplace set up under the Affordable Care Act.

Berger who has been vocal in his longstanding opposition to Medicaid expansion said Wednesday that he had changed his mind because circumstances have changed.

The state Medicaid program has moved from fee for service to managed care, a change Senate Republicans pushed to control expenses.

Challenges to the Affordable Care Act, in Congress and in the courts, have repeatedly failed to repeal or overturn it. “The Affordable Care Act is not going away,” Berger said.

In past years, Berger raised suspicions that the federal government would not continue to pay 90% of the cost of care for people insured under expanded Medicaid. The federal government has kept paying. The bill proposes that hospital taxes would pay for the remaining 10%.

The Biden administration has offered the 12 states that have resisted Medicaid expansion an additional financial incentive that would bring an about $1.5 billion to the state over two years.

“Medicaid expansion has now evolved to the point where it is good state fiscal policy,” Berger said.

In the Senate Health Committee, Democrats thanked their Republican colleagues for the changing their minds on expansion.

“I’m just delighted that you all have picked up this ball that some of us have wanted for 10 years now,” said Sen. Mike Woodard, a Durham Democrat. “I hope we can pick it up together and carry it across the goal line.”

The bill includes a work requirement. The Biden administration has rescinded Medicaid work requirements in states that had them approved under the Trump administration.

It was clear during the committee discussion that not all sections of the Senate bill are universally popular.

The NC Medical Society wants Medicaid expansion but doesn’t want advanced practice registered nurses to be able to work independent of doctors’ supervision, said Medical Society CEO Chip Baggett. Doctors have been fighting increased autonomy for advanced practice nurses for years, and several senators questioned the move Wednesday.

Jordan Roberts of the John Locke Foundation said the legislature should drop the expansion and stick with “supply side reforms.”

The bill would have a major impact on hospitals.

Hospitals have worked for Medicaid expansion for years, but they’ve also fought to keep the Certificate of Need law and don’t want to change it now.

“Any changes to the program would put already vulnerable hospitals at much greater risk of having to make difficult decisions as new entrant healthcare providers could pick off commercially insured patients without taking on responsibilities of caring for Medicaid, under-insured or uninsured patients,” association spokeswoman Cynthia Charles said in an email.

Hospitals’ finances have been strained since the pandemic because they are facing a labor shortage that has forced them to use more expensive contract workers, she wrote. Hospitals have faced “frequent claim issues” under the Medicaid managed care plans, and were hit with an unexpected $200 million state tax last year.

“At a time when hospitals are dipping into their reserves to fund operations, this is not the time to lean on hospitals to fund expansion, or to look at repealing or changing the current certificate of need law,” Charles wrote.


Critics say new NC school bill is not needed, will hurt LGBTQ students

Kendra Johnson, Equality NC executive director

The state Senate is set to begin debating proposed legislation that would require schools to tell parents if their children want to change their pronouns or seek counseling, and would ban teaching about sexual orientation and gender identity in K-3 classrooms.

The provisions are part of a larger measure that Republican sponsors say would make it easier for parents to know what’s being taught in school and about counseling their children receive. Under the bill, parents would be able to go to court to get information if they are not satisfied with responses to their questions.

Critics said the bill is not needed, and is a distraction from the legislature’s failure to provide adequate school funding.

“It’s dangerous,” Equality NC Executive Director Kendra Johnson said in an interview. “We know that LGBTQ students are harassed. This level of policing is deeply problematic.”

NCAE President Tamika Walker Kelly


Tamika Walker Kelly, president of the NC Association of Educators, said Republicans are trying to divide teachers and parents for political gain instead of talking about funding schools under the Leandro mandate.

The bill draws attention away from the day to day issues at schools, she said, such as inadequate pay and lack of school counselors.

“Our lawmakers are once again showing their disconnect from the reality on the ground in our schools and our community,” she said.

These kinds of bills are being pushed by Republican legislatures and governors in other states.

In Florida, Gov. Ron DeSantis signed what’s known as the “Don’t Say Gay” law that prohibits instruction about sexual orientation and gender identity in K-3 and classroom discussion of those topics. The law also prohibits discussion about sexual orientation or gender identity at certain grade levels, leading some Florida teachers to worry how to respond to student questions about diverse families. NBC reported on two Florida teachers who quit because of the law.

Text of the North Carolina bill was not available online Tuesday night, but Senate leader Phil Berger discussed it at a news conference late Tuesday afternoon.

Berger said the proposal’s section on K-3 instruction differs from the Florida law.

“There is no attempt to squelch folks from talking about things,” Berger said. Parents should know whether their children are receiving counseling.  And if parents ask school employees whether their children are asking questions about sexual orientation, the school should tell them.

“If my child asks a question about something like that, I think I would want to know about it,” Berger said.  “It would be incumbent upon the school incumbent upon the school to notify a parent that those are the kinds of inquiries the child is engaged in.”

Berger said he didn’t believe the bill has a notification requirement, but “if the parent asks, the parent has the right to know that.”

The bill is being debated in the shadow of the midterm elections. There’s no guarantee Democratic Gov. Roy Cooper would sign the bill if it gets through the legislature. But the issue and legislators’ votes could become fodder in election campaigns.

Johnson called the bill “a solution is search of a problem” because schools aren’t teaching about sexual orientation or gender identity in K-3 classes.

“It sounds like the “Don’t Say Gay” bill in Florida,” she said. “Schools should be inclusive spaces for all genders, people of all religious backgrounds. It should be a place where we bring all of ourselves.”

A strong relationship between parents and educators leads to student academic and social success, Walker Kelly said. Parents can already get the information about school instruction that Berger described, she said.

“When students come to school, they have the right to be affirmed and seen in the classroom,” Walker Kelly said. “To restrict conversation about the diversity of families can be harmful to students in our schools.”

NC grant program for schools was so popular, the money ran out in less than a week

School districts snapped up the small grants available purchase feminine hygiene products for students with funding from the state budget, but there wasn’t enough money to go around.

Sixty-six school districts and charter schools received grants of $500 to $5,000 to purchase feminine hygiene products for students, according to a report to the legislature from the state Department of Public Instruction. DPI distributed the money on a first-come, first-served basis, as the legislature directed.  The $250,000 the legislature appropriated was claimed in less than a week, and fewer than half of the 134 applications were funded. The legislature made the money available only this year.

In their requests, the school districts wrote of low-income students who missed school, had to use wadded-up toilet paper, or make embarrassing trips to the front office for supplies because their families could not afford them.

At some schools, employees use their own money to buy tampons or pads for students whose families cannot afford them. Other schools rely on a PTA or community donations.

“All grantees indicated a great need for student access to feminine hygiene products as they may not have access to them at home or their families may not have the financial means to purchase products themselves,” DPI’s report said.

“More than half of the grantees indicated that they either have Title I schools in their districts or that many of their students and families are living below the poverty line. For these students and families, feminine hygiene products are an expense they cannot afford, and therefore they have to rely on the school to provide these products. Many grantees also noted that an increase in the availability of hygiene products in school would help students stay in school when are menstruating and would alleviate student anxiety and embarrassment.”

With the realization that period poverty causes students to miss school, states have begun passing laws requiring public schools to provide menstrual hygiene products or providing school money to purchase them, Policy Watch has reported.

“As many grantees indicated, there is a direct link between student academic success and the provision of hygiene products in school,” DPI said in its report to legislators. “The grant program has helped to support districts and students by removing financial barriers to products and ensuring health and well-being is maintained so that students continue their academic growth.”

Fifteen states have laws providing menstrual hygiene products in schools, Stateline reported this month, citing information from the Alliance for Period Supplies.

The DPI report said school districts still ask about the grant program, with questions about when more money might be available.

State Sen. Natalie Murdock, a Durham Democrat, filed a budget bill last year asking for the money, and the grant made it into the final budget. Murdock said in an email this week that getting the money in the budget was a bipartisan effort, with GOP Sens. Deanna Ballard, an education budget committee chairwoman, and Kathy Harrington, a Senate budget chairwoman, championing it.

Ballard and Harrington could not be reached this week.

The DPI report shows the need to continue to fund the grants, Murdock said in the email.

“With so many schools across the state applying for the funding, it shows that there is a real need for these products in our schools,” she wrote.

NC Court of Appeals sides with media seeking public records on jail detainee’s death

The Forsyth County District Attorney didn’t follow court rules when he sought to prevent a state agency from giving a news organization documents about a jail detainee’s death, a state Court of Appeals opinion says.

The opinion issued Tuesday said District Attorney Jim O’Neill “failed to follow the requirements of the Rules of Civil Procedure in filing its Objection and Request for Temporary Protective Order.”

O’Neill in January 2021 asked the Forsyth Superior Court for a temporary restraining order to prevent the state Department of Health and Human Services from giving documents to The News & Observer relating to the death of John Neville.

Neville died in December 2019, three days after jail deputies hog-tied him and held him on his stomach, The News & Observer reported.

The Superior Court initially granted the restraining order. A coalition of media companies asked the Superior Court to dismiss it. The Superior Court dissolved the protective order in February 2021. O’Neill appealed. The state Attorney General’s office handled the appeal.

When O’Neill first asked for the restraining order, he didn’t notify The News & Observer. No member of the media coalition was named as a party or was notified to appear in court, the Appeals Court opinion said. DHHS was told about the objection but did not get a summons and was not named as a party.  “In fact, the Record is devoid of any summons commencing the matter whatsoever,” the opinion said.

This amounted to a failure to follow the Rules of Civil Procedure.

The Appeals Court did not decide whether the documents are public records.

Overturning Roe could be an election “game changer,” Duke experts say

Deondra Rose and Asher Hildebrand

Deondra Rose, assistant professor at the Sanford School, and Asher Hildebrand, associate professor of the practice.

Overturning the constitutional right to abortion has the potential to shake up North Carolina elections, Duke University experts said Tuesday.

The Supreme Court’s abortion decision could transform the U.S. Senate race in North Carolina and focus national attention on legislative races this fall, they said.

Politico reported on a draft opinion written by Justice Samuel Alito that overturns the 1973 landmark decision Roe v. Wade. The opinion concerns a Mississippi abortion law that would ban the procedure after 15 weeks of pregnancy.

The draft opinion puts women’s reproductive freedom at center stage in an election year where the economy, inflation, and gas prices are top issues, said Deondra Rose, an assistant professor at Duke University’s Sanford School of Public Policy.

“This could be the issue that could mobilize young voters, certainly in the primaries and potentially in the general election in November,” Rose told reporters Tuesday.

The opinion is one that could help increase turnout for Democrat Cheri Beasley, Rose said. Beasley, a former state Supreme Court chief justice, does not face major competition in the Democratic primary for U.S. Senate.

With trends favoring Republicans, attracting younger voters “is absolutely necessary to give, in my opinion, Democrats a fighting chance in the Senate race,” Rose said.

National political analysts have predicted Republicans will keep the U.S. Senate seat Richard Burr is vacating, Policy Watch has reported. Candidates in the crowded GOP primary include U.S. Rep. Ted Budd, who has former President Donald Trump’s endorsement, former Gov. Pat McCrory, and former U.S. Rep. Mark Walker.

The opinion will likely convince national groups to become active in North Carolina legislative races, said Asher Hildebrand, an associate professor of the practice at the Sanford School. Hildebrand is a former chief of staff to Democratic U.S. Rep. David Price, who is retiring.

“I do think this could be a game changer, in that it raises the perception of the stakes, especially among Democratic and Democratic-leaning voters,” he said.

Gov. Roy Cooper, a Democrat, has vetoed anti-abortion bills, Policy Watch has reported.  Republicans hold majorities in the state House and Senate, but when they lost their veto-proof majorities in 2018, they lost the ability to override Cooper’s vetoes on their own.

Republicans are working to regain their veto-proof majorities this year.

“You can bet that a lot of the national money that would not have come to North Carolina otherwise will start coming into the election,” Hildebrand said. “For the next two years, at least, we have divided government. From the perspective of Democrats and those who are concerned about the apparent ruling that was leaked last night, preventing a Republican super-majority in the General Assembly has got to be a huge goal.”