NC Republicans Seem to Have Changed Their Tune on Medicaid Expansion. So What’s Different?

Sen. Tammy Baldwin, D-Wis., Sen. Raphael Warnock, D-Ga., right, discuss proposed legislation last year that would expand Medicaid access at the federal level. (AP Photo/J. Scott Applewhite)

By Michael McElroy

June 29, 2022

The politics might be different, but it has long been known that expanding Medicaid would significantly improve the lives of more than 600,000 low-income North Carolinians.

North Carolina is as close as it has ever been to expanding Medicaid, a monumental change that could improve the lives of more than half-a million people.

Close, however, might still be too far, and this time the fight is among Republicans. 

Local healthcare providers, advocates for low income families, Gov. Roy Cooper, and most other state Democrats have long called for North Carolina to expand Medicaid coverage, especially since the US government would cover 90% of the state’s costs. But at nearly every pass over a decade, state Republicans were unified in resistance. 

(North Carolina is one of only 12 states that, so far, have refused to expand Medicaid and accept those federal funds.)

Then, suddenly this summer, state Senate Republicans changed their tune, with even Senate Leader Phil Berger, once one of the most vocal critics of expansion, saying Medicaid expansion was “the right thing to do.” 

The Senate passed a bill expanding Medicaid this month and the House did the same this week, but the details of those competing bills are significantly different over scope and payment. For example, the House version creates another committee to study the impact of expanding Medicaid, which would be the second time in a year the legislature has created such a body. It also delays any action on final approval of a full plan until December, while the Senate bill aims to move more quickly.

Republican leadership across the two chambers of the General Assembly are now the ones fighting over the details, and a final vote is not at all assured. 

But the chambers have never passed a form of an expansion bill so it’s significant that the state is even on the cusp of doing so. 

Many people may be wondering what swayed Senate Republicans to get behind the move Democrats have been calling for for a decade. Did they see some new and game-changing evidence of the benefits of Medicaid expansion? 

Not at all. The benefits have been clear for years.

Countless studies, as well as the experiences of 38 states that have already expanded Medicaid, have long since shown that expansion significantly improves the lives of hundreds of thousands of low-income North Carolinians.

So while Republican leaders now argue among themselves, let’s take a look at what healthcare officials and advocates have long known.

In North Carolina, there are some 600,000 people who make too much money to qualify for Medicaid under current parameters, and who make too little to receive healthcare subsidies.

This is a huge gap. Expansion would fill it. 

According to the Kaiser Family Foundation, more than 400 studies show a clear link between expanding Medicaid and improved access to quality healthcare, better health outcomes, less medical debt. And they also show that people who have gained access to health insurance use it: They are more likely to go to the doctor and are less likely to leave serious conditions untreated.Expansion would also:

  • prevent many rural hospitals from having to close.
  • create nearly 100,000 new health care jobs.
  • reach more than 14,000 uninsured veterans.

It would protect families from financial ruin, and, without question, it would save lives. 

“A study found that Medicaid expansion was associated with nearly 12 fewer deaths per 100,000 adults each year in expansion states,” the North Carolina Department of Health and Human Services wrote, arguing for Medicaid expansion.

“That is because people with health coverage are more likely to get preventative care, more likely to catch and treat diseases like cancer and heart disease early, and less likely to skip medications because of the cost.”

Expansion would also increase access to mental health and substance abuse treatment, the NCDHHS said. 

“In 2019 more than 55% of people who needed it did not receive [mental health] treatment because of cost. The COVID-19 pandemic has exacerbated the mental health crisis in this country. Untreated mental illness can lead to homelessness, involvement in the justice system, and trauma to children. Twenty-seven counties in NC don’t have a psychiatrist.”

Expansion would go a long way toward addressing some of these disparities, the NCDHHS said. 

Nearly everyone would benefit.

According to the Kaiser Family Foundation, the North Carolinians who would become eligible for Medicaid under an expansion live all over the state. Though many people in the coverage gap live in rural areas, Kaiser says, there are very large numbers in the most populated counties too, including Wake and Mecklenburg.

And those who would benefit are racially diverse: 50% are white and 50% are people of color. 

“Expanding Medicaid in NC,” the NCDHHS says, “would bring affordable health coverage to more than 100,000 low-income parents with children at home, including thousands of parents of children with special needs.”

So while Senate Republicans seem to have finally seen the light, it’s not because the light has gotten any brighter. 


  • Michael McElroy

    Michael McElroy is Cardinal & Pine's political correspondent. He is an adjunct instructor at UNC-Chapel Hill's Hussman School of Journalism and Media, and a former editor at The New York Times.

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