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Two to watch in health care: Medicaid, abortion

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Technically speaking, women's health and abortion rights proponents should have nothing to worry about in 2014. But, as advocates point out, anything is possible when it comes to activist anti-abortion rights legislators seeking change.

In the final days of the 2013 session, the GOP commandeered a seemingly innocuous bill on motorcycle safety and inserted language to force far-reaching and potentially costly regulations on abortion providers.

"They never cease to amaze me," says Adam Linker, a policy analyst for the left-leaning N.C. Justice Center's Health Access Coalition. "If they can do it, they will."

Last year's bill barred sex-selective abortions and abortion coverage for individuals with government insurance plans.

It also called on state health officials to draft regulations intended to police abortion clinics like ambulatory surgical centers, an expensive requirement that forced the closure of dozens of clinics in other Republican-controlled states. The N.C. Department of Health and Human Services is currently readying those regulations.

And while lawmakers typically use the General Assembly's short session to tinker with the state's budget plan, they may also take up legislation that stalled after passing in either the House or Senate last year.

Of the measures eligible for consideration this year, two—House Bills 716 and 730—include abortion language that was later bundled into last year's sweeping legislation, potentially opening up the possibility of rewrites on 716 and 730 that are intended to curb abortions in North Carolina.

Abortion rights advocates have pointed out that Republicans nationwide have followed a similar script in limiting access to abortions on the state level.

"We're optimistic because, in some sense, they got through all they wanted last year and it's an election year," said Paige Johnson, spokeswoman for Planned Parenthood of Central N.C. "But there are legislators who will not be satisfied until providers of safe and legal abortion are shut down. We know that."

One of the most important health care debates in 2014 will deal with reforms in how the state dispenses Medicaid funds, Linker said. Republican leadership rejected federal Medicaid expansion last year that would have extended coverage to another 500,000 North Carolinians who don't qualify.

Linker said Republicans across the country have softened their stance on the expansion since last year, and North Carolina may still qualify for roughly $2 billion in federal aid if it reverses course this year. "I believe they are more receptive than their rhetoric suggests," said Linker.

Meanwhile, state officials will vet a proposal from Gov. Pat McCrory's office intended to eliminate recurring Medicaid shortfalls. Among those proposals, networks of medical providers would share in Medicaid cost overruns in exchange for incentives aimed at keeping costs down.

Health care advocates might also watch House Bill 498, a bipartisan measure that passed the House last year but did not advance in the Senate. The measure orders health benefit plans, including state plans for teachers and state workers, to cover treatment of autism spectrum disorders.

The treatment, which can require therapy 40 hours a week for some severe cases, can be expensive for parents of children with autism, according to Rep. Tricia Ann Cotham, a Mecklenburg County Democrat and former schoolteacher who co-sponsored the legislation last year with three House Republicans.

"If we work with children intensely at a younger age, we can better the rest of their quality of life," said Cotham. "I see that as a parent and an educator."

Cotham said she will push for the legislation's passage in 2014, although she said she believes there is little interest in the state Senate.

She said the measure garnered the opposition of insurance giant Blue Cross Blue Shield and the National Federation of Independent Business, which touts itself as the country's leading association for small businesses. Both complained the legislation would be too costly for businesses and the state, Cotham said.

According to the Autism Society of N.C., a nonprofit advocate, one out of every 58 children in North Carolina will be born with some form of autism. The national rate is one of 68. More than 60,000 people in North Carolina live with the disorder, the group says.

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