For the first time in over 140 years, Republicans are leading both chambers of the North Carolina General Assembly. They came in with a comprehensive list of legislative goals, hoping to overturn and roll back some of the more burdensome policies of the liberal regime.
Within their extensive legislative agenda, healthcare was certainly not left untouched. On the national level, America has seen the passage of the intrusive Patient Protection and Affordable Care Act, or “Obamacare.” As a result, more than half of the states have individually or jointly filed lawsuits to challenge the constitutionality of the federal legislation. In addition, individual entities and several unions as well as entire states have requested waivers from the most oppressive sections of Obamacare.
At the state level, the Republican majority in the state Legislature has vowed to make health care more affordable while protecting North Carolinians from predatory federal mandates.
One of the promises included in the new majority’s 10-point legislative agenda was to pass the Healthcare Protection Act, “exempting North Carolinians from the job-killing, liberty-restricting mandates of the federal Patient Protection and Affordable Care Act.”
They almost succeeded. HB 2, the “Protect Healthcare Freedom Act,” was filed in late January. By late February, it had passed both chambers and was sent to Governor Perdue. Unfortunately, she chose to veto this legislation and the legislature has, so far, been unsuccessful in overriding the veto.
Instead, North Carolina joined Minnesota in filing an Amicus brief to the lawsuit currently in the U.S. Court of Appeals for the Eleventh Circuit. The lawsuit, filed by almost half of the states, challenges the constitutionality of Obamacare. An Amicus brief is filed by an individual or an entity that is not a party to the litigation but has an interest in its outcome, usually siding with one of the parties to the case.
In the brief, GOP leadership argued that the federal government is encroaching on states’ rights and individual liberties by mandating individuals to purchase health insurance while forcing states to absorb additional healthcare costs.
Leadership should be applauded for taking a step to challenge this overreach of federal intrusion into states’ rights. However, this same GOP-led legislature has also attempted to push through an unnecessary health insurance exchange bill in response to Obamacare.
Legislative leaders have argued that if a state chooses not to provide its own exchange by January 1, 2014, the federal government, under the Health and Human Services Secretary, will set up an exchange for it. So far, however, there has been little guidance from the federal government on key questions concerning what the exchanges should include and how they should be run. Not to mention if Obamacare is found unconstitutional, the resources and time spent on setting up an exchange become completely moot.
Nevertheless, despite research indicating exchange failures in other states, legislators on both sides of the aisle offered health benefit exchange legislation. Throughout the process, the main contender became HB 115, the “NC Health Benefit Exchange Act.” This bill would set up an exchange with a mix of federal money and funds from the state’s high-risk pool as well as fees on those who buy insurance policies through the exchange. It would be governed by a 12- member board of directors comprised of businesses, health insurance, medical providers and public representatives in addition to the Commissioner of Insurance and Director of the Division of Medical Assistance who will serve as ex officio members. So far, it appears to have died in the Senate but it could always re-emerge in a later session.
The legislature could have better spent its time attempting to override Governor Perdue’s veto of HB 2, or consider legislation that would allow the purchase of health insurance across state lines, or even form a Healthcare Compact.
In another major development, state lawmakers worked to find a fair solution to the financially strapped State Health Plan (SHP). SHP is the insurance coverage for more than 660,000 state employees, retirees and dependents. SHP faces a budget hole of more than half a billion dollars over the next two years – in addition to the billions of taxpayer dollars already spent on the plan.
The original bill intended to address the SHP’s financial woes. However, the “State Employee Health Plan” (SB 265) was vetoed by Governor Perdue purportedly because she opposed the introduction of a premium-sharing plan for enrollees, though her own budget proposal included premiums as well. In response, the legislature offered two follow-up compromise bills, SB 323 and HB 578. These bills transfer the SHP to the state treasurer, double the in-network deductible, but offer a premium-free 70/30 base plan for at least one year based on available cash reserves. This option may continue through 2013 if the board of trustees can find funds to support the basic plan. After 2013, or if there is not an adequate cash reserve after the first year, the 70/30 enrollee premium will return unless the legislature readdresses this issue. This second round of legislation survived without a veto from Perdue.
Without the cash reserve, the basic 70/30 plan will be offered at roughly $11 per month while the 80/20 standard plan premium will be $22 per month. Both plans seem extremely reasonable for an employee premium contribution – though liberals and Governor Perdue will tell you state employees cannot afford such a “burdensome” premium. In the May 2011 Civitas Institute poll, 62 percent supported legislation requiring state employees to contribute between $11 and $22 towards their own health insurance. Even with the premium contribution, North Carolina’s SHP would remain among the lowest state employee premium plans in the nation.
Finally, the General Assembly has begun to streamline the Department of Health and Human Services (DHHS) and the health-related legislative committees and commissions. Under HB 618, “Streamline Oversight/DHHS Service Providers,” a task force would be established to streamline duplicate and unnecessary oversight of DHHS services. HB 595, “Reorganization/ Legislative Oversight Comns,” offers a new structure for several legislative committees, including establishing a Joint Legislative Oversight Committee on Health and Human Services, merging the Study Commission on Aging, the Joint Legislative Health Care Oversight Committee, the Joint Legislative Oversight Committee on Mental Health, Developmental Disabilities and Substance Abuse Services, and the Public Health Study Commission. Both bills passed the House and Senate, and await Governor Perdue’s signature or veto. These bills should provide more efficiency in health-related state agencies and within the General Assembly.
Overall, the North Carolina legislature has worked diligently to turn back years of oppressive and inefficient regulations. In the realm of healthcare, much was accomplished but there is still room for improvement, especially within the area of dismantling Obamacare.
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