‘We’re ready to make history.’ After 10 years, NC legislature approves Medicaid expansion

  • Oops!
    Something went wrong.
    Please try again later.

The North Carolina General Assembly approved Medicaid expansion Thursday and sent the legislation to Gov. Roy Cooper, who is expected to sign it.

The House voted 87 to 24 in favor of House Bill 76, “Access to Health Care Options,” which would extend federally subsidized health care to thousands of North Carolinians. Members of the House applauded the bill’s passage and rose in a standing ovation, prompting House Speaker Tim Moore to call for order.

The bill would allow adults who make below 138% of the federal poverty level to be eligible, which the state’s Department of Health and Human Services has said would apply to around 600,000 low-income North Carolinians.

The passage of HB 76 does not immediately enact Medicaid expansion. The bill is tied to funding in the state budget, which lawmakers will craft over coming months. If the budget does not pass, neither can expansion. The law would take effect once the budget becomes law and the federal government approves a start date.

Legislators’ overwhelming backing for this year’s Medicaid bill marks the conclusion of a decade-long saga during which Republican lawmakers swung from staunch opposition to fervent support. Republican Gov. Pat McCrory signed a bill rejecting Medicaid expansion in 2013, the year before coverage took effect in many states through the Affordable Care Act.

As recently as 2019, Cooper and top Republicans were still in a standoff over Medicaid expansion’s inclusion in the state budget — resulting in the state’s failure to approve a budget. But in late 2021, Republican leaders began to shift their stance on expansion.

Moments before the bill’s passage Thursday, Rep. Donny Lambeth, a Republican from Winston-Salem and one of the bill’s primary sponsors, addressed the House.

“I was pondering how much I wanted to go through this — pick these last eight years — I thought I could go through each year by year, but then I decided that I might get run out of town,” he joked. “So all I’m gonna say to you is thank you, thank you, thank you.”

Lambeth has pushed for expansion far longer than most in his party and was a key player in finally getting the legislation passed.

“This has been a long, bumpy road, but we’re ready to make history,” he said Wednesday.

Following the bill’s passage, Cooper tweeted his support: “Medicaid Expansion is a once in a generation investment that will make all North Carolina families healthier while strengthening our economy, and I look forward to signing this legislation soon.”

Under current law, childless adults are not eligible for Medicaid and qualifying parents or caretakers must earn no more than 41% of the federal poverty level. The state also provides coverage to children, people who are blind or disabled, and those over age 65 or pregnant — within certain parameters.

This has led to complications for some in receiving coverage. Many earn too much income to qualify for Medicaid but not enough to receive subsidies that allow them to buy other insurance. Bill sponsors also say HB 76 would allow for increased healthcare access for low-income individuals living in rural North Carolina.

Lambeth, citing the state’s health department during Wednesday’s floor debate, said that passing Medicaid expansion would increase federal funding awarded to North Carolina, including $4.8 billion a year billed to Medicaid on behalf of newly insured North Carolinians and $3.7 billion in payments to hospitals.

The House initially filed an expansion bill in February that later became an updated compromise following discussions between leaders from both chambers.

“There’s been a lot of time put into building a consensus on this bill, addressing a lot of the concerns that folks had on our side of the aisle in terms of cost predictability, how it would affect folks staying or remaining in the workforce,” House Speaker Tim Moore, a Kings Mountain Republican, said.

Cooper is expected to sign the bill into law. The Democratic governor has long featured Medicaid expansion as a central facet of his administration’s platform. North Carolina is currently one of 11 states that has yet to sign Medicaid expansion into law.

“An agreement by legislative leaders to expand Medicaid in North Carolina is a monumental step that will save lives and I commend the hard work that got us here,” Cooper previously said in a statement.

Budget negotiations have been a contentious sticking point between Cooper and the Republican-held General Assembly in years past. That Medicaid expansion is dependent on a budget passing might give legislators leverage to force policy issues Cooper would otherwise veto.

Heidi Perez-Moreno and Kyle Ingram are freelancers with NC Insider, The News & Observer’s state government news service. They are both seniors at UNC-Chapel Hill.