Republicans file healthcare reform bill

In this Monday, March 4, 2019 photo, Dr. Allison Magnuson, Geriatric Oncology and Breast Oncology at Wilmot Cancer Institute, right, speaks with patient Nancy Simpson at the Pluta Cancer Center in Rochester, N.Y. Instead of assuming that elderly patients are too frail for treatment or recommending harsh drugs tested only in younger patients, cancer doctors are taking time to evaluate their physical and mental fitness, along with emotional and social well-being. (AP Photo/Adrian Kraus)

RALEIGH — As Democrats make Medicaid expansion in North Carolina their legislative priority, Senate Republican health leaders introduced a bill they say will expand care to the truly vulnerable — the intellectually and developmentally disabled, and those needing mental health treatment.

Sens. Joyce Krawiec (R-Forsyth) and Dan Bishop (R-Mecklenburg), who together co-chair the Senate Health Committee and the Senate Health and Human Services Appropriations Committee, held a press conference Tuesday to announce what they are calling the Health Care Expansion Act of 2019, Senate Bill 361.

“I understand that expanding Medicaid is a top agenda for many, but let’s give some thought to what that actually means,” Krawiec said at the press conference. “Medicaid expansion means taxpayer-funded health insurance for able-bodied, jobless adults.”

Krawiec pointed to average seven-year wait times for the families who have disabled children in the IDD Medicaid program, and she said using $41 million to fund 2,000 more slots over the next two years should be the priority.

“To us, this IDD population, these folks that have been waiting for a number of years, who have severe needs, should always be put ahead of able-bodied working adults,” she said. “Until all the truly needy from that IDD list are taken care of, we should not even be considering expanding Medicaid.”

The legislators were asked why both could not be achieved, to which Bishop responded, “Resources are always limited. So, what we’re obliged to do is make intelligent choices, not easy choices, not necessarily political simplistic choices.”

Some Republicans in other states have expanded Medicaid, and Bishop brought up the visiting John Kasich, the former governor of Ohio and 2016 presidential candidate.

“I understand Gov. Kasich is around, perhaps, today,” Bishop said. “With all due respect, Gov. Kasich is the poster child of why Medicaid expansion is a reckless course for a state government. Ohio legislators are struggling with the financial impact of the Medicaid expansion there, which I believe was unilateral by the governor.”

The bill also eliminates Certificate of Need (CON) regulations, which Bishop called a “permission slip” of bureaucratic hoops that health care providers needed to jump through to open for business. CON has been controversial for many years, with free market proponents pushing for its elimination as an unnecessary barrier and hospital lobbyists saying they are necessary to protect a fragile status quo with endangered rural hospitals.

The federal government used to mandate these regulations, but in 1987 they reversed the requirement and 15 states have subsequently eliminated them. There are 28 areas of treatment and care that require a CON from state government, and smaller providers claim the requirements are often insurmountable or, at the very least, too expensive.

“The Health Care Expansion Act of 2019 would completely eliminate CON laws from North Carolina to increase provider competition, enhance patient choice, lower costs and improve access,” Bishop said.

The bill also addressed expanding access to mental health treatment with a pair of regulatory changes. One would allow cross-state treatment from providers licensed in a half-dozen states that are part of the Psychology Interjurisdictional Compact. This would allow telemedicine and even visits by these mental health providers. The other change would allow licensed marriage and family therapists (LMFTs) to perform first evaluations for involuntary commitments.

The bill, S.B. 361, was filed on March 26 and has not yet been assigned to any committees for consideration.