Gov. Roy Cooper on Monday signed — as expected — the Republican-sponsored state budget into law.
Cooper also set Aug. 15 as the date the COVID-19 state of emergency for North Carolina will be lifted.
The governor’s office said House Bill 103 includes changes in the state’s emergency management requested by the N.C. Department of Health and Human Services “to ensure flexibility that is currently made possible by the governor’s COVID-19 State of Emergency.”
Cooper said in a brief statement that he signed the 2022-23 state budget bill primarily because it “includes critical investments in education, economic development, transportation and the state workforce.”
After vetoing the state budgets for 2019-20 and 2020-21 — in large part because they did not include Medicaid expansion legislation — Cooper cited the progress made during the 2022 session on separate bills backed by Republican leadership in the House and Senate.
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Senate Bill 408, which includes Medicaid expansion, was approved by a 101-6 vote in the House on June 28.
SB408 has been sent to the state Senate, which passed its own bipartisan, multi-layered healthcare bill — House Bill 149 — that expands Medicaid to between 450,000 and 650,000 North Carolinians.
Those who might be eligible under the expanded program are between the ages of 18 and 64 and earn too much to qualify for Medicaid coverage, but not enough to purchase coverage on the private insurance marketplace.
A sizable portion of enrollees during the pandemic likely would qualify for expansion coverage.
A pivotal turning point for both Berger and Moore on their Medicaid expansion stances is enabling North Carolina to gain access to about $1.5 billion in federal Medicaid expansion funding over a two-year period.
That would free up DHHS to re-direct General Fund dollars to other priorities; $1 billion would be used to address substance abuse and mental health.
The key elements of SB408 are helping preserve rural hospitals and directing DHHS to develop a Medicaid Modernization and Savings Plan with a Dec. 15 deadline for filing a report with a joint oversight legislative committee.
“We need to know exactly what we’re getting” from Medicaid expansion, particularly in terms of expanding access to healthcare providers “in a manner that is cost-effective,” Moore said, “This way, we have certainty ... and the final say.”
If the legislative oversight committee approves the plan, Moore had pledged that SB408 would receive an up-and-down vote soon after.
“We believe this bill will help address some really critical needs while being fiscally responsible to taxpayers and without incentivizing a person not to get a job,” Moore said, citing a potential work requirement for eligible enrollees.
Budget response
The N.C. Healthcare Association considered HB103 as a good step forward toward improving public health in the state.
“We urge the General Assembly to build on their budget process and success by moving before the end of the year to pass both the Healthcare Access and Stabilization Program and Medicaid expansion,” the association said.
“Acting quickly on these measures is essential to stabilize struggling hospitals and to provide access to affordable health insurance to more than 600,000 additional North Carolinians, including veterans, working people without health insurance and families with children. “
The significant support from Democrats in both chambers likely persuaded Cooper not to risk the first veto override since the Republicans lost their super-majorities after the 2018 general election, said John Dinan, a political science professor at Wake Forest University.
“The budget bill this year passed with the support of so many Democratic members of the House and Senate that it seemed certain to take effect, whether as a result of the governor signing it, or the governor allowing it to become law without his signature, or the governor issuing a veto that would be overridden with the help of some Democrats,” Dinan said.
“The only drama was over which of these routes the budget would take to eventual passage, and today the governor chose the first.”
Cooper’s decision to sign the state budget bill was not a surprise to legislative analysts given the votes in each chamber, said Mitch Kokai, senior policy analyst with conservative think tank John Locke Foundation.
Kokai said the separate comments from Cooper and the Republican legislative leaders “suggests that a Medicaid expansion proposal is still on the table.”
“Regardless of the rest of the budget, Cooper almost certainly would count movement on Medicaid expansion as a win.”
State of emergency
North Carolina is one of 13 states that has not ended its COVID-19 state of emergency, with Georgia being the only other Southeast state with that status.
Cooper did not provide comment on the decision to end the COVID-19 state of emergency on Aug. 15.
In April, Cooper extended until July 15 some state regulatory waivers that continue to allow for extensive COVID-19 response measures.
Some of the waivers date back to Cooper’s first pandemic-related executive order issued on March 10, 2020, which declared a statewide state of emergency. Some of the waivers have since been extended up to 14 times.
Cooper has said previously extensions of COVID-19 related waivers had the same reasoning behind it — providing flexibility for health care workers and care facilities, as well as easier access to vaccines, tests and treatments.
For example, the extension continues to allow state Health Secretary Kody Kinsley to issue standing orders to facilitate additional COVID-19 testing and vaccinations resources, and the administration of therapeutic treatments designed to treat the coronavirus, including monoclonal antibody treatments and newly authorized therapeutic treatments.