With dozens of rural hospitals closing in the wake of COVID-19, North Carolina Republicans are realizing that dead constituents have a difficult time voting GOP and and now finally working with state Democrats and Gov. Roy Cooper to expand Medicaid in the state after resisting it for more than a decade.
The top leaders in North Carolina’s legislature reached an agreement that is expected to expand Medicaid coverage. The momentous deal, announced Thursday, is the culmination of more than a decade of political wrangling and a Republican change of heart.
The deal will allow North Carolina, at no cost to state government, to give health insurance to hundreds of thousands of the state’s working poor. The federal government will pay for 90% of the cost, and the rest will be covered by a new tax on hospitals and insurance companies.
House Speaker Tim Moore said that factor — as well as the fact that the federal government will also pay North Carolina $1.8 billion extra if expansion passes — was a big motivating factor for GOP leaders like him to change their minds and support Medicaid expansion, after spending over a decade fighting against it.
“I mean, it’s staggering numbers,” Moore said.
Democrats have pushed for expansion for years. The state had around 900,000 uninsured residents in 2021 — nearly one in every 10 people — and expanding Medicaid would allow most of those people to have health insurance.
But Republicans fought it, in part because of its association with former Democratic President Barack Obama — Medicaid expansion only exists because of Obamacare — but also because of fears that Republicans in Congress would repeal Obamacare, leaving states on the hook for the extra costs of expansion. After national Republicans failed to repeal Obamacare under President Donald Trump, despite controlling both Congress and the White House, it put local GOP leaders more at ease about the future of the program.
Another major factor that caused GOP lawmakers to change their minds in 2022: The 2021 stimulus package, signed into law by Democratic President Joe Biden, that offered signing bonuses to states that expanded Medicaid — in North Carolina’s case, the $1.8 billion that Moore mentioned.
Biden reacted happily to Berger and Moore’s announcement Thursday. “This is what I’m talking about,” Biden said in a statement, adding for national context: “That'll be 40 states who've expanded. 10 more to go.”