Medicaid remains sticking point between GOP, Dems in NC’s budget

MM Curator summary


The fight over Medicaid expansion may derail the NC state budget again this year.


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RALEIGH, N.C. (WNCN) – Republican House Speaker Tim Moore said this week that the possibility of expanding Medicaid coverage has come up in talks with Gov. Roy Cooper (D), but that there is still not enough support among his party’s members to include that in a final budget agreement.

The issue was one of the key reasons Cooper and the Republican-controlled legislature never agreed on a budget two years ago, as the governor has pushed for expanding the program to cover hundreds of thousands more lower-income people.

Republican legislative leaders have declined to do that, with Senate leader Phil Berger saying recently he still thinks it’s “bad policy.”

Still no end in sight for NC budget negotiations

Cooper, Berger and Moore are having private discussions about a potential budget compromise and have not made public what aspects of it they’re still trying to resolve with each other.

North Carolina is among 12 states that have not expanded Medicaid, according to the Kaiser Family Foundation.

Chrissy Burk is a working mom of two who lived in Fayetteville for 23 years until she moved to Ohio three weeks ago.

While living in North Carolina, she was uninsured and faced financial hardship.

“I had gotten so comfortable without having (health insurance), I learned how to move around not getting hurt or sick, or if I did using self-remedies, soothing myself,” she said.

She said she moved in with family in Toledo, taking just her clothes and her boys with her. Ohio is among the states that have expanded Medicaid.

“Since I’ve been here in three weeks, me and my kids were covered through Medicaid and I’ve already gotten a job, and I’ve only been here three weeks. And, the only thing I did different was leave the state of North Carolina,” she said.

Democrats in Congress recently tried to entice the remaining states that have not expanded Medicaid by offering to have the federal government pick up even more of the cost for two years. Under the Affordable Care Act, the federal government covers 90 percent of the cost, leaving states responsible for the rest. The American Rescue Plan included a provision to cover a 5 percentage point increase in the match rate for two years.

The Kaiser Family Foundation found that after accounting for the state’s cost for doing that, there would be a net increase of $1.2 billion in funding for North Carolina.

There’s also discussion of including a coverage option for people in states that have not expanded Medicaid in the $3.5 trillion so-called “human infrastructure” bill being debated in Congress.

North Carolina House Speaker Tim Moore said there are still outstanding questions about what that would mean for North Carolina if that passed.

“There’s questions about what impact does that have on the state. And, frankly, a lot of the time has been spent looking into… what would happen. What would it cost the state?” he asked. “A lot of real policy questions along there and we still can’t get them answered because we can’t get a clear answer from DC on them.”

Casey Cooper, CEO of the Cherokee Indian Hospital Authority, has been talking to leaders in Republican-leaning counties in the western part of the state, explaining to them the potential impacts of expanding Medicaid.

He pointed to working people who either don’t have insurance through their employers or can’t afford to purchase it themselves. He said that leads to some people forgoing treatment until they become so sick they have to go to the emergency room, which is much more expensive.

“Medicaid expansion is absolutely essential for small rural hospitals who are already operating on razor-thin margins,” he said.

Commissioners in Clay County adopted a resolution urging state lawmakers to expand Medicaid joining Graham, Jackson, Macon and Swain in the western part of the state, according to Care4Carolina.

“I think that perhaps maybe some of the resistance is just a lack of understanding and not understanding that Medicaid expansion is really the solution to this problem that our friends and families live with every single day,” he said.

Some conservative groups have been urging Republicans not to expand Medicaid.

Americans for Prosperity-North Carolina recently said it’s prepared to “launch a full-scale campaign to combat the effort.”

“As Senator Berger and most legislators who identify as ‘fiscally responsible’ have said for years: Medicaid expansion is— and always has been— bad policy. While some are letting the guise of unreliable federal funding dissuade their principles, our activists are gearing up to remind policymakers that Medicaid expansion will only exacerbate fiscal challenges for our state and North Carolina’s hardworking families,” said AFP-NC state director Chris McCoy in a statement.

It’s not clear how close Republicans and Gov. Cooper are to reaching a budget agreement. Republicans planned to send a counter-proposal to him this week. They haven’t said what the remaining issues are to resolve.


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