Gov. Roy Cooper’s budget puts Medicaid expansion back “on the table”

The proposed budget Gov. Roy Cooper released last week included his long-time priority, Medicaid expansion for 500,000 North Carolinians without health insurance.

The standoff over Medicaid expansion between Cooper and the Republican-led legislature contributed to Cooper vetoing the state budget in 2019.

Cooper said at a news conference last week that he would not veto a budget over one issue, but he would not sign a budget that was “not right for North Carolina.”

“Getting more health care coverage to people in North Carolina is certainly a priority,” he said. “Medicaid expansion is the best way to do that. Everything is on the table this budget session. I’ve agreed with the legislative budget leaders that we want to put everything on the table. We hope that each side gets what it wants – that we work together to reach a budget I can sign.”

Medicaid expansion offers health insurance to adults who earn up to 138% of the federal poverty level. North Carolina is one of a dozen states that has not adopted Medicaid expansion, according to the Kaiser Family Foundation.

Republicans who control the state legislature have opposed expansion since it was first adopted as part of the Affordable Care Act, back when Bev Perdue held the governorship.

Republicans have offered various reasons over the years for opposing expansion – that Medicaid was “broken,” that expansion would cost the state too much, and later, that they did not want to expand the Medicaid population while the state was shifting from fee-for-service to Medicaid managed care.

The federal government picks up 90% of the costs for people who get Medicaid coverage under state expansions. Most of those who covered under expansion are low-income, childless adults.

Senate Republicans said they did not like an expansion-like plan that House Republicans devised that would have had hospitals pick up costs the federal government did not pay. That bill never made it out of the House.

The most recent federal COVID-19 relief package includes financial incentives for states that have not yet expanded Medicaid.

The Kaiser Family Foundation estimated that North Carolina would net $1.2 billion if it expands Medicaid.

Senate leader Phil Berger, an expansion opponent, told the Associated Press earlier this month that the extra money is time limited, and that coverage gaps could be addressed without “creating a whole new level of entitlement in the state of North Carolina.”

Cooper late last year created the bipartisan NC Council for Health Care Coverage to come up with ways to get coverage to more people. The Council developed a set of guiding principles, but did not settle on one strategy.

So far, Republicans have proposed bills with limited reach, such as the proposal to allow parents on Medicaid whose children are temporarily taken into foster care to keep their coverage.

In a Facebook post last week, Sen. Kevin Corbin, a Macon County Republican, said he was working on a bill with Sen. Jim Burgin, a Harnett Republican, that looks at expanding health coverage for working families.

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