Medicaid Expansion Becomes Reality After Months of Delays

A midnight session of the General Assembly, where the House passed the budget 32 hours after it was made public.

By Dylan Rhoney

September 25, 2023

A half-million North Carolinians waited more than a decade for Republicans to stop their blockade of federal aid for more affordable healthcare.

When the North Carolina General Assembly passed Medicaid expansion, they tied funding for the expansion to the state budget, meaning those eligible for coverage would only receive access once the state budget was passed. Gov. Roy Cooper opposed the linking of the two, but ultimately signed the expansion, eager to expand Medicaid however he could after a decade of Republican inaction on the issue.

After several months of delays, Republican leaders—Senate Leader Phil Berger and Speaker of the House Tim Moore—addressed reporters about some of the specifics of their agreement and confirmed that Medicaid expansion funding would be in the budget.  On Wednesday afternoon, the North Carolina General Assembly made their budget public after months of delays. Just 32 hours later, at 12:28 in the morning, the North Carolina House of Representatives passed the budget in a 70-40 vote. The Senate held a session at 9:30 on Friday to approve the budget. 

The final sign-off on expansion is a relief for nearly 600,000 North Carolinians who will soon be eligible to enroll in Medicaid, as well as some of those who lost access to the program  over the past several months amid the end of a pandemic-era policy.

But the consequences of Republicans’ delay are real and substantial. The expansion was initially supposed to take effect on Oct. 1st. However, due to the legislature’s months of inaction on the budget, North Carolina Secretary of Health and Human Services, Cody Kinsley, announced earlier this month that his office would not be able to implement Medicaid expansion as scheduled.

 

‘What About the Medication I Need in October?’

Yeisel Dominguez lives with bipolar disorder and relies on Medicaid for health insurance. She is eligible for expansion, but because of the delay, she will fall into the coverage gap on Oct. 1st. The Moore County resident says she and her husband looked at options for private health insurance, but they were simply unaffordable. 

“We got quoted for $1,000 [per month]. Nobody really has that kind of money to spare.” she said.

While Dominguez will regain access to Medicaid after the expansion is implemented, she will still lose coverage at the end of this month and is concerned about having access to the medication she needs. 

“What about the medication I need in October?” she said. “Everything is so expensive, medication especially.”

She also worries about what a lack of coverage could mean for her family. 

“If I don’t have the right treatment for my severe anxiety and bipolar disorder, I’m being stopped from being a good wife and mom,” she wrote in an op-ed for Cardinal & Pine. “I want to be the best for my family. I don’t want my husband having to worry about how he’s going to pay for my medication.”

 

Cooper Races to Implement Expansion

Shortly after the vote in the Senate, Cooper released a statement criticizing some of the budget’s contents and the process surrounding its passage, but said that he would allow the budget to move forward so Medicaid expansion could finally become a reality in North Carolina.

“Health insurance for 600,000 more North Carolinians that brings more mental health and substance use disorder treatment, help for desperate rural hospitals and billions of dollars into our economy is a life-saving, monumental decision for our state,” Cooper said. “I will not allow people who are crying for help to wait any longer, so I am directing our Department of Health and Human Services to begin today the process of expanding Medicaid while allowing this budget to become law without my signature.” 

Uncertainty surrounding the budget was a source of fear and frustration for everyday citizens and Democratic legislators, who felt they were left in the dark by the Republican supermajority that controls both chambers of the General Assembly.

Buncombe County State Rep. Lindsey Prather expressed frustration that the budget process was dragged out for so long, and that access to healthcare that was promised to hundreds of thousands of people was delayed due to politics. 

“It is playing partisan politics with people’s lives, literally. There are 600,000 people in North Carolina that should be on Medicaid right now because of legislation that we voted on, passed, and that our governor signed,” she said. 

‘Like a Dream Come True’

Doctors and lawmakers alike believed that rural North Carolina in particular sorely needs Medicaid expansion. Dr. Laura Ucik, who practices medicine in Henderson, says uninsured patients will benefit greatly from expansion. 

“If you think of any step of trying to get medical care, all of it is costly and confusing and difficult if you don’t have health insurance,” she said. 

Ucik, a primary care doctor, believes expansion will also help with preventative care. “Prevention is really how we change lives, and Medicaid expansion will allow us to prevent things. Not just cancer screenings, but to get people to specialists.”

Alma Hawkins of Oxford advocated for Medicaid expansion for many years. While she and others who advocated for it are thrilled that it will finally become law, there is still a sense of frustration that it took so long. 

“It’s like a dream come true,” she said. “It shouldn’t have been a dream. It should have been something that common sense dictated.”

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