RALEIGH, NC (AP) — After a decade of strong opposition, most North Carolina Republicans have now embraced the idea of expanding the state’s Medicaid program to cover hundreds of thousands of additional low-income adults. Legislative approval is finally within reach.
During the General Assembly session that ended July 1, the GOP-controlled House and Senate passed bipartisan measures separated by wide margins that would put the state on a path toward Medicaid expansion. Some details remain to be ironed out, but there is a real opportunity to reach a compromise by the end of the year.
It’s a remarkable political shift in North Carolina, sure to be scrutinized in the dozen states that have yet to accept the federal government’s offer to cover people who earn too much to be insured by traditional Medicaid but too little to be insured. subsidized private.
“If there’s one person in the state of North Carolina who has spoken out against Medicaid expansion more than I have, I’d like to meet that person,” Senate Leader Phil Berger said when trying to explain his repeal at a hearing. press conference in May. “We need coverage in North Carolina for the working poor.”
The two chambers were unable to resolve their differences before adjourning, and talks between legislative leaders and Democratic Gov. Roy Cooper, a longtime expansion supporter, have stalled ever since, at an impasse over other reforms. of health care senators are seeking. But Berger remains optimistic about ultimate success. “I think we’ll get there,” he told reporters recently.
“There’s a lot of work to be done … but overall we’re very encouraged by how far we’ve come,” said Erica Palmer Smith, executive director of Care4Carolina, a coalition of 150 groups that has worked to expand since 2014.
Other advocates are tired of waiting. They say many of the working poor are uninsured and risking their health and lives. Others on traditional Medicaid worry that without the expansion, they will no longer be covered if they make too much money.
“I don’t know what to do,” said Courtney Crudup, 32, of Oxford, a mother of three and a cosmetologist who is currently unemployed. She spoke this week outside the Legislative Building at an event urging lawmakers to act. “Listen to our stories. Listen to normal people like me and people who want to work.”
The apparent change of heart followed years of GOP suspicion over the Affordable Care Act of 2010, which Republicans derided as “Obamacare” only to see the label, as well as the program, become wildly popular. .
For years, Republicans said they couldn’t trust Congress to keep the federal government’s promise to pay 90% of expansion costs. They said the state’s Medicaid program, now with 2.7 million enrollees, had been overspending for years and wasn’t prepared to take on more.
And crucially, they argued that more people would become dependent on the government if they were allowed to benefit from Medicaid, which now primarily serves poor children and their low-income parents and the elderly.
Republicans say Medicaid spending in North Carolina is now largely under control and don’t think Congress will increase the state’s share of cost beyond 10%. The state’s share, perhaps as much as $600 million annually, can be covered by hospital assessments and state insurance plans.
Interest also grew when the 2021 federal COVID-19 relief package offered a financial sweetener to encourage remaining holdout states to agree to the expansion. For North Carolina, whose tax coffers are already full thanks to a thriving economy, that would be an additional $1.5 billion over two years.
“This is an opportunity to take federal dollars, save the state of North Carolina, and increase access to health care,” House Speaker Tim Moore told colleagues in June. “I would say that’s a pretty good trifecta for doing those things.”
Cooper can also take credit for his persistence. He has pushed nonstop for expansion since he took office in 2017, citing the economic boost the federal money would bring to rural hospitals, communities and the families of the 600,000 residents who might qualify.
Cooper went so far as to veto the 2019 state budget because Moore and Berger did not commit to the Medicaid talks. He signed this year’s bill, saying “we are closer than ever to an agreement on expanding Medicaid” and that a veto “would be counterproductive.”
A pivotal moment came after the 2020 election, when Cooper convened a bipartisan commission of medical, business and nonprofit leaders and state legislators who proposed “guiding principles” to improve health care coverage.
“People with quite different political views were willing to listen to those who are approaching these issues from different backgrounds and concerns,” said Mark McClellan, director of the Duke-Margolis Center for Health Policy at Duke University, which convened the commission. .
Another influencer was former Ohio Governor John Kasich, who told a joint House-Senate committee in March how expansion has worked out in his Republican-leaning state. The committee focused on details, including how to increase the number of nurses, hospital beds and services in the state.
Negotiations slowed this summer between the House, Senate and Cooper, in large part because the Senate wants regulatory changes aimed at providing even more access to services that it says will result in lower costs.
They include giving nurse practitioners, certified nurse midwives and others the ability to work independently of doctors, and reducing “certificate of necessity” laws that critics say allow medical providers to limit competition that could reduce their revenue. .
Berger blames the hospitals for refusing to accept a compromise. The North Carolina Health Care Association, which represents hospitals and health systems, said it has raised concerns about Berger’s bill but remains a proponent of expansion.
“It’s a good thing that both chambers now support expansion, and right now hospitals hold the key to doing that,” said Ford Porter, a spokesman for Cooper.