Lawmakers return to Raleigh with health care policy wish lists

This story was originally published online at NC Health News.

Amid smiles, photos, receptions and family members crowding the Legislative Building in Raleigh on Wednesday, lawmakers involved in health care policy-making said they were preparing their priority lists for the legislative biennial that began this week.

The first issue on both sides of the aisle? The issue that seems enduring in the past decade: whether North Carolina will join the majority of states and expand Medicaid to provide coverage for more than half a million low-income workers.

Senate Leader Phil Berger (R-Eden) highlighted Medicaid’s expansion in a speech after he was elected leader for the seventh time since 2011, saying it was one issue that “the legislature must address.”

“I support expanding Medicaid in North Carolina,” he told a large Senate crowd.

Berger spent a decade opposing the action, But he changed his position in 2022. He weaved his bill through the Senate last year, only to deadlock in the House.

“We have to realize that it is not a silver bullet,” he continued. North Carolinians are saddled with some of the highest healthcare costs in the country. We need to eliminate regulatory red tape and other bureaucratic barriers that impede access to care and unnecessarily increase medical costs.”

Berger’s 2022 Medicaid Expansion Bill also included provisions that would 1) overhaul rules around competition in hospitals in North Carolina and 2) give nurse practitioners more freedom to work independently of physicians.

Berger, in a media interview following the swearing-in ceremony, reiterated his position.

“In order to get … the broad, bipartisan support that we had for the Medicaid expansion bill that we’ve had before, there needs to be some measure that addresses the supply side,” he told reporters. “If you’re going to give 500,000 to 600,000 people an insurance card that says they have the right to get their Medicare, we need to do something that hopefully opens up more access to more primary care providers, more facilities where they can be treated.”

Old disagreements may resurface, though, as House members and Tim Moore (R-Kings Mountain), the re-elected Speaker of the House, have spoken of a “clean” Medicaid expansion bill that doesn’t include mentions of nurses or hospitals.

Rep. Donnie Lambeth (R-Winston-Salem) acknowledged that some of Berger’s concerns will need to be addressed before the two chambers can reach any agreement. House committee assignments are not made public, but Lambeth has been a key player from the House on committees with members of both legislatures addressing health care issues.

“I think we have to do a need repair certification,” he said, referring to hospital competition laws. “So my second bill is going to be a certificate of need bill that I’ve been working on with the industry. And I think we have to get that done in order to do the expansion.

“That was some kind of Senate note.”

Mental health is on the minds of many

Republicans and Democrats have noted the importance of addressing mental health needs across the state.

Lambeth said he recently attended a forum on mental health best practices with nurse Carla Cunningham (Dee Charlotte), and pharmacist Wayne Sasser (R Albemarle). Lambeth said they are interested in doing some of the things that other countries are doing.

“I think we need more psychologists in schools, because I think we need to reach out to these kids and listen to those kids in a more proactive way,” Lambeth said. “We’ve talked about having more guidance counselors and psychologists in schools, and we’ve done a little less of that. But I think we need more.”

Lambeth would also like the legislature to consider funding mental health crisis centres.

said Sen. Sidney Patch (D-Apex), who is a member Social worker and family law attorney. She has been appointed to the Senate Health Care Committee.

“Children sit in hospitals for far too long without proper places for them,” Patch said. “We have a mental health crisis in the foster care system. And then also within our schools every single day, we really need to have mental health professionals who see children, identify them, and address their needs.”

Batch introduced a bill in the last session that would have provided treatment spaces for mental health providers in schools, with priority given to children who lack health insurance or a regular caregiver.

said Rep. Donna White (R-Clayton), a nurse who has played a key role in shaping legislative health care policies. “We’re just not trying to figure out what’s causing our young people’s mental health problems.”

The lists are long

Representative Hugh Blackwell (R-Valdesi) said that during the swearing-in ceremonies he began jotting down a list of priorities he wanted to work on in the next biennium on a slip of paper. House committee assignments have not been announced, but Blackwell said he expects to be appointed again to health care committees.

At the top of that list were mental health issues, but he ticked a number of other topics, including getting patient information in state-run healthcare facilities onto electronic health records.

Another of his concerns was about employment in healthcare.

“I think, at Broughton Hospital, for example…we have probably over 100 beds that aren’t being used, because we don’t have the right staff for that,” said Blackwell.

Last year, leaders in the Department of Health and Human Services indicated to lawmakers that they I faced a huge shortage of staff In all of their departments, including state-run hospitals.

Sen. Jim Perry (R-Kinston) also had health care workforce issues, and mentioned a shortage of child care workers.

Availability of qualified manpower and personnel to work in those facilities, [of] Affordability—Wages are over the limit, Berry said. “We have to try to figure out a few things… get a healthy workforce. Mom and Dad should have someone to take care of the kids so they can go to work.”

Other healthcare topics that topped lawmakers’ lists included:

  • Addressing mental health issues faced by foster children, a topic raised by Patch and Senator Mike Woodard (D-Durham). Woodard said he worries about how to do that Children in foster care find it difficult to access health care If they move from one district to another in the state — something Patch tried to address in a bill he championed last year.
  • White said she’s ready to make another run at making her room behind the Conservation Act, which will give it to her More autonomy for advanced practice nurses. Last year, 75 sponsors of the bill participated in the House of Representatives, but it never came to a vote. “I think I can get that many [sponsors] White said. “I haven’t met all the freshmen and I don’t know what their views are on a lot of things, but it’s definitely a whole new group to consult with, and I will very soon.”
  • Lambeth said he would like to address some of the issues related to getting other healthcare workers into the educational pipeline. “The first is the workforce for doctors in rural areas. Whether we do loan forgiveness or other programmes, we have to do something to address the shortage in some rural areas,” added Lambeth. “We’ve met some community colleges. What they tell me is, ‘We have the space, we have qualified applicants, we don’t have coaches, we don’t have enough money.'”
  • Abortion has been mentioned by many lawmakers on both sides of the aisle. Woodard indicated that Senate Democrats plan to introduce a bill codifying constitutional protections for abortion that were vetoed in Supreme Court last summer Dobbs resolution. Republicans, for their part, have talked about a range of possibilities for a potential bill limiting the measure. “We’ll see what, if anything, the General Assembly can pass and stand up to a veto,” Berger said.

Wednesday was just the beginning of a process that will continue over the coming months and possibly years. Many initiatives require government funding, which will pit interest groups against one another—and lawmakers know how frustrating that can be.

“Everything requires money, and that’s why you can never do everything at once,” Perry said. “It’s not that something is important or unimportant, it’s just that resources are scarce.”

North Carolina Health News is an independent, nonpartisan, not-for-profit, statewide news organization dedicated to covering all things North Carolina health care.

Leave a Comment