RALEIGH, N.C. (AP) — North Carolina Gov. Roy Cooper on Monday signed Medicaid expansion legislation that had been in the works for a decade and gives the Democrat a historic victory, though he remains a significant hurdle before the coverage can be implemented, thanks to a Republican-backed provision.
In a ceremony at the executive mansion attended by hundreds of people, Cooper celebrated the passage of the expansion legislation, which he has been eagerly seeking since being first elected governor in 2016. It took Republicans in charge of the General Assembly this long to buy into the idea and agree to provide coverage for more low-income adults, with the federal coffers paying the bulk of it.
North Carolina is among 11 states that have not accepted federal government expansion. States with Republican leaders have recently considered expansion after years of opposition.
“This law, when implemented, will be the working families bill of the decade,” Cooper said. “Today is a historic step toward a healthier North Carolina.”
The measure contains a clause that Cooper opposed, requiring that a separate state budget law be first enacted in order for the expansion to be accepted and implemented. This makes the registration start date unclear and gives the GOP leverage in future negotiations.
Still, Monday’s new law is expected to mean government-funded health coverage for potentially 600,000 adults who earn too much to qualify for traditional Medicaid but too few to qualify for heavily subsidized private insurance. Billions of dollars will also flow annually from Washington to the state. North Carolina currently has 2.95 million Medicaid enrollees, but Cooper said many more suffer from a health care coverage gap, having to ignore treatable and preventable illnesses.
“While a solution was just out of reach, with this law that I’m about to sign many of them will be close enough to catch it,” Cooper said, standing next to the Speaker of the House. Tim Moore, Senate Leader Phil Berger and other expansions. supporters.
Earlier this month, the two lawmakers finalized a brokered deal that contains looser expansion and “certificate of need” regulations on healthcare facilities before they can open more beds or use equipment. expensive. The House and Senate approved the deal separately, with the final vote taking place on Thursday.
Republicans in charge of the legislature had for years overturned the idea of expansion that came out of the 2010 Affordable Care Act. This led to litigation against Cooper and budget standoffs between them.
But GOP leaders have reversed course lately, confident that the state’s Medicaid program was financially sound with a shift to managed care, and that Congress would not repeal the 2010 law or increase the share of 10% spending required by the state.
“We now have a stable Medicaid system,” Berger said. “By transforming our state’s Medicaid program, we are now in a place where our system can handle these additional enrollees.” Republicans were also lured by an additional $1.75 billion payment over two years for North Carolina from the federal government if it expanded Medicaid.
A persistent coalition of supporters of the expansion – with the governor and his cabinet in the lead – had helped push for a deal.
“I’m grateful to Governor Cooper, who pushed the need for health care from the beginning and didn’t stop until it was over,” said Cassandra Brooks, who owns child care centers near Raleigh. and advocated for expansion after two of its uninsured teachers died prematurely.
The expansion fight between Cooper and the legislature began during his first week as governor in 2017. Cooper tried to get President Barack Obama’s administration to approve his expansion request before Donald Trump does not come into operation. Moore and Berger successfully sued to block the efforts, citing in part a 2013 state law preventing expansion without express General Assembly approval.
In 2019, Cooper’s demand that the expansion be negotiated contributed to a state budget standoff with GOP lawmakers that was never fully resolved.
The 2021 Finance Bill contained language to convene a Blue Ribbon Legislative Committee that looked at expansion and other ways to improve access to healthcare. The Senate and House have approved competing expansion measures in 2022, but negotiations have stalled. They resumed this winter.
Requiring passage of the budget for expansion provisions to be enacted means Republicans could stuff the budget bill with unrelated items that Cooper opposes. Republicans are now just a House legislator reluctant to exercise non-veto control in the General Assembly.
“I’m confident we can work together to get something we can agree on,” Cooper told reporters after the signing, adding that Medicaid expansion is now a matter of “when” not of “if”.
Monday’s legislation directs that state expansion spending be paid for with hospital assessments. Hospitals will also receive money to treat patients from the Medicaid expansion, and the law will enroll them in a federal program for larger reimbursements.
