Principles for theNCGA’s ‘Access to Healthcare & Medicaid Expansion Committee’


The 2021 state budget, which was signed into law before the new year, created a joint legislative committee on “access to healthcare and Medicaid Expansion.”


Senate Leader Phil Berger and House Speaker Tim Moore recently named nine members from both chambers to serve on the committee. Its first meeting will be held in February. The committee will make recommendations to be considered by the full North Carolina General Assembly.


As the committee meets and does it work, it is important for lawmakers to stay laser-focused on the North Carolina healthcare consumer by following these core principles.


1)   Improve Access to Care


One of the best ways to improve access to care, especially in rural areas, is by increasing the supply of high-quality, high-trained providers. Currently, regulations on the books in North Carolina prevent high-skilled nurses from practicing at the full level of their education and training.


By removing the burdensome, unnecessary, and outdated requirement that Advanced Practice Registered Nurses get an agreement from a physician to supervise their work – a requirement that is already being waived to expand access to care during COVID-19 – the committee could greatly expand access to high-quality care.


Reforming the state’s “Certificate of Need” laws will also go a long way in increasing access to care.Currently, if someone wants to open a new healthcare facility, they must get permission from the government by demonstrating a “need.” This limits access to new, innovative behavioral health and substance abuse services, and new dialysis home care services. Reforming CON laws will increase access to new and better care.  


2)   Increase Affordability


Reforming CON laws will also help bring down healthcare costs for consumers. For example, allowing new, more value-driven and cost-effective dialysis treatment care options to open would increase competition. Increased competition drive costs down while improving quality.  


Similarly, removing the requirement for Ambulatory Surgical Centers to obtain a CON will offer consumers more affordable care options and increase competition. ASCs provide many of the same services a large, fully equipped hospital can, but at a much lower cost. 


Studies have also found that by simply allowing high-trained nurses to practice at the full level of their education and training could save up to $4.3 billion.


3)   No Cost Increasing Mandates


During the legislative session we saw several mandates introduced that would significantly drive-up costs for consumers.


The most egregious mandate would have forced families and businesses, through their insurance premiums, cover (i.e., pay for) any healthcare service provided virtually if it’s covered in-person.


This could have put patients on the hook for emails, text messages and chats with their doctor – or between two doctors when the patient isn’t even involved.


The mandate would have even gone so far as to allow hospitals to bill patients for in-person charges such as facility fees, even if they are being cared for virtually.


Any attempt to revive this mandate should be rejected by the committee.


4)   Expand Medicaid


The committee should strongly consider a responsible, workable solution for North Carolina to expandMedicaid.  


The state has already transitioned to Medicaid Managed Care. Finding a way to provide affordable insurance to an additional 500,000 uninsured individuals will lessen the burden on businesses and workers to subsidize the cost on uncompensated care, and thus drive down premiums.


Moreover, if the state does not act quickly, it may lose the ability to shape Medicaid expansion in the way that best serves North Carolina. The Biden Administration and Congress are already looking at ways to bypass states and force expansion onto those that have not already done so. The clock may be ticking on legislators to find a North Carolina solution.



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