Why top NC Republicans changed their minds on Medicaid for ‘working poor,’ and what’s next

·2 min read

North Carolina should join most other states in the country in expanding Medicaid coverage to lower-income residents, some Republican leaders said Wednesday morning.

“We need coverage in North Carolina for the working poor,” Senate leader Phil Berger, formerly an opponent of Medicaid expansion, said at a news conference.

A new bill they are backing does not contain only Medicaid expansion, which is a longtime goal of Democratic Gov. Roy Cooper and others. The proposal, published Wednesday morning as House Bill 149, also contains several other changes to health care policy — like free-market “certificate of need” changes and looser regulations supported by nurses — that have previously withered in the face of opposition from groups representing doctors or hospitals.

But Sen. Joyce Krawiec, a Kernersville Republican who leads the Senate’s health committee, said she thinks hospitals will support this bill not only for Medicaid expansion but also because it contains other things hospitals want, like increased telehealth options.

“I think this bill is a rescue plan for our hospitals, especially our rural hospitals,” she said.

So why are Republicans suddenly in favor of a policy in Medicaid expansion that they have long, and vocally, opposed?

Berger signaled his change of heart last year, saying it happened after he decided North Carolina no longer needed to worry about the federal government keeping up its end of the bargain.

There are several factors, he said Wednesday. One is that Congress failed to repeal President Barack Obama’s Affordable Care Act — even when Republicans controlled both the White House and Congress — followed by the Supreme Court upholding the law as constitutional. If that had gone away, costs for Medicaid expansion would have shifted from the federal government to individual states.

Chances for Medicaid expansion this year?

However, it remains to be seen how quickly the bill might move forward, or if it will pass. While Republican leaders in the N.C Senate are behind it, N.C. House Speaker Tim Moore has voiced skepticism of Medicaid expansion in the past.

Asked last week if it was on the table for this spring’s legislative session, Moore told reporters, “I would be surprised.”

Sen. Gladys Robinson, a Democrat from Greensboro, thanked Republican senators during a committee hearing on the bill Wednesday morning for not only supporting Medicaid expansion — which Democrats have sought for years — but also for explicitly mentioning that it will help the working poor.

”I hate to say I told you so, in terms of the working poor, but I have to do that,” she said.

When Berger was explaining his support of the bill, he gave an example of a single mom who’s working full time and making $25,000: Not much money, yet still too much to qualify for Medicaid unless expansion passes.

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