North Carolina General Assembly Passes Medicaid Expansion Bill

600,000 North Carolinians are set to gain health coverage after a Medicaid expansion bill passed General Assembly after a decade-long fight. Source for photo: Chapelboro.com

On Monday, March 27th, North Carolina Governor Roy Cooper signed House Bill 76, Access to Healthcare Options into law. The Medicaid expansion bill has been pushed by Democrats for years in North Carolina and continuously faced backlash. However, Republicans shifted their stance on the bill, likely due to realizations of issues COVID-19 highlighted within the healthcare industry and the lessening antipathy towards former President Obama. With this new position, lawmakers in the NC General Assembly came together to pass the bill in bipartisan fashion, which will provide 600,000 people with healthcare coverage. 

The Affordable Care Act (ACA), also referred to as Obamacare, passed in March 2010. Its main components are Medicaid expansion and affordable health insurance. It has provided health insurance to over 35 million Americans. However, the ACA has faced many acts of reprisal as it has been challenged in the Supreme Court numerous times and faced countless other lawsuits. 

In 2012 the Supreme Court ruled that Medicaid expansion was optional for states to adopt. Subsequently, half of the states failed to adopt it – North Carolina being one of them. However, there has been a large push for the Tar Heel state to opt-in and provide health coverage to the hundreds of thousands of low-income North Carolinians who live without it. 

The NC Senate finally adopted the expansion measure almost unanimously on March 15th. The House adopted it with a vote of 87-24 on March 23rd. Almost two-thirds of Republicans in the chamber voted in favor. This support comes after almost a decade of opposition, so why the sudden change of heart? 

In May of 2022 NC Senate Majority Leader Phil Berger spoke out about his new position and support for expansion contingent on whether or not the law could be embedded with budget negotiations. Tim Moore, the Speaker of the NC House, and Berger thus worked on an agreement and proposed the bill in early March. The change in position from Republicans plausibly comes from a few major incentives the bill provides to the state along with COVID-19 impacts and the lessening opposition to Obama. 

The ACA received enormous backlash after its implementation. Largely fueled by their dislike of large social spending and their increasing political incentive to block any of former President Obama's domestic bills from succeeding, in order to position themselves to take back control of Congress and the Presidency that Democrats swept under the former president." Republicans nationwide pushed back against the program. However, as time has passed since the Obama presidency, it is likely these feelings have subsided towards the program and an awareness of its benefits have become apparent. 

A realization that the ACA is here to stay has permeated throughout the country as the program has withstood various court challenges. Legislators in North Carolina also had a large financial incentive to adopt the bill because The American Rescue Plan Act of 2021 would award NC with $1.75 billion dollars if it expanded Medicaid. 

It is important to note the effects COVID-19 had on NC. Low-income individuals without health insurance lived in fear throughout the pandemic and many were faced with large medical bills they were unable to pay.

North Carolina is home to many rural areas which face issues in providing health care and keeping hospitals open at significantly higher rates. The Governor’s Office states people who live in rural areas are 40% more likely to be uninsured. Eleven rural hospitals have also shut down in NC since 2005 and many others continue to struggle as they are providing large amounts of uncompensated care. Therefore, expansion of Medicaid will have notable impacts on rural NC residents and their hospitals. 

Arguably, after the global pandemic and health issues facing millions of people in NC, health coverage became a pertinent issue for people on both sides of the aisle and led the way for this landmark legislation. 

The bill is expected to have a massive impact. NC residents whose incomes are up to 138% of the federal poverty level are eligible for Medicaid under the expansion. This percentage is equivalent to around $41,000 for a family of four and it is expected to offer coverage to 600,000 people. Individuals such as teachers, veterans, and healthcare workers are among the groups expected to benefit. 

The bill will also provide much-needed relief to rural communities and hospitals that are financially struggling. Governor Cooper has also stated Medicaid will bring around 40,000 jobs to the state along with the $1.75 billion signing bonus. 

The impacts the bill will have on NC are considerable, but they will not take action until the 2023 budget passes the General Assembly as Republicans tied the Medicaid expansion bill to the passage of the budget. This will likely give Republicans an opportunity to get things on their agenda passed in the budget without Democrats blocking it. The budget is expected to pass in the next three months. While this contingency appears discouraging, Governor Roy Cooper is optimistic about its success. “I think what’s important about this is that we have agreed on how to expand Medicaid, and it’s only a question of when and not if,” said Cooper. 

“This is a historic moment that will transform the health and well-being of North Carolina. Medicaid expansion is foundational in improving access to health care in rural areas, for better mental health, and for veterans, working adults, and their families. For 600,000 people, Medicaid expansion is life-changing,” said Secretary of Health & Human Services Kody Kinsley.

The ability of Republicans and Democrats in North Carolina to reconcile their decade-long debate on Medicaid and pass a bipartisan bill that will bring both economic and health benefits to the state and its residents should be celebrated and will bring significant impacts to NC in the near future.