After more than a decade of limbo, North Carolina became the 40th state in the country to expand Medicaid on Monday.
Gov. Roy Cooper signed the legislation into law, and support from the state’s GOP legislature could mean other red states might follow.
A bipartisan group of state legislators joined the Democratic governor for a bill signing ceremony Monday afternoon. Cooper said the change will improve the state's healthcare landscape.
"It’s clear that this legislation I’m signing today will have a positive effect for all working families even if they don’t directly get Medicaid," he said. Cooper thanked Republicans for their "willingness to change their minds to find a solution that worked for North Carolina."
For much of the past decade, Republican legislative leaders opposed expanding the Medicaid program to more than 600,000 new recipients. They cited cost overruns in the state’s existing Medicaid program, and they worried that Congress might repeal the Affordable Care Act and leave states stuck with the bill for more Medicaid recipients.
Since then, the state has fixed its Medicaid budget. And the federal government has sweetened the pot: A big factor for North Carolina leaders is that expansion now comes with a $1.8 billion signing bonus. Paired with another federal healthcare stabilization program, officials estimate that North Carolina will get a $8 billion injection of funding for health care needs.
House Speaker Tim Moore says that makes the math work.
“Now it stays within budget,” Moore said at a news conference. “You now have an opportunity now that you’ve managed that to be able to find a way to responsibly expand that coverage because of these additional funds that are there.”
Hospitals think the funding is a game-changer in a state where many rural hospitals are struggling and some have closed.
“This money is going to be a lifeline for hospitals and not just for them being able to continue operating services at the same level or expanding, but also being able to be those economic drivers in their communities as an employer,” said Nicholle Karim of the N.C. Healthcare Association, which represents hospital systems.
But even as North Carolina Republicans changed their minds on expansion, 10 other GOP-dominated states continue to be holdouts. Most are in the Southeast, including Florida and Georgia.
Political scientist Chris Cooper of Western Carolina University says that could soon change.
“I think it makes sense that some of our neighboring states might look to North Carolina and see how you can change your mind, and you can still keep your electoral fortunes,” Cooper said. “We're also seeing states like South Dakota — other Republican states, not in our region — at least put this to a vote of the people and also expand, so this is the rare kind of issue that’s becoming less partisan over time.”
Supporters of Medicaid expansion in North Carolina still have to wait a few more months. The bill signed Monday will take effect when the state enacts its annual budget. That’s expected to happen this summer.
Chris Cooper notes that Republican lawmakers also got some long-sought victories in the Medicaid bill, including a measure to reduce health care facility regulations known as Certificate of Need. And Medicaid expansion won’t take effect until this year’s state budget is approved, giving the GOP more leverage over the governor in developing a spending plan.
“We will see when the state budget gets released from the House this coming week," the political scientist said. "What kind of poison pills might be contained in that budget."