Photo By Al Drago/CQ Roll Call
Photo By Al Drago/CQ Roll Call

North Carolina’s Republican-led legislature could expand Medicaid to cover 600,000 more residents this year, but they could also try to ban abortion in the state, robbing their constituents of their reproductive freedom.

The reproductive freedom, healthcare, and democratic rights of millions of North Carolinians are on the line this year, as the North Carolina General Assembly begins its new session at noon on Wednesday. 

Republicans once again control both chambers of the legislature after winning a veto-proof majority in the Senate in November’s midterm elections and coming just one seat shy of a veto-proof majority in the House. The GOP’s lopsided majorities—aided by the partisan gerrymandering of the state’s legislative district map—put them one step closer to overriding Democratic Gov. Roy Cooper’s vetoes and  implementing their far right agenda on North Carolina. 

Here are the key issues to keep an eye on over the coming months:

Medicaid expansion

Thirty-nine states have adopted the Affordable Care Act’s (ACA) Medicaid expansion, an opt-in program that allowed states to expand Medicaid health insurance coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level ($18,755 for an individual in 2022), with the federal government covering 100% of the cost for the first several years, and 90% of costs as of 2020. 

But under Republican leadership, North Carolina is one of 11 states that has failed to expand Medicaid, even as it would provide access to affordable health insurance coverage for more than 600,000 North Carolinians, including more than 100,000 low-income parents with children at home.

In 2022, the legislature came closer than it ever had to expanding Medicaid, passing two separate bills in the House and Senate, but ultimately, Republicans leaders failed to agree on a final bill.

If the legislature is able to finally get expansion done in 2023, it would be welcome news for the state’s residents. Medicaid expansion has been shown to save lives, with one study finding that Medicaid expansion led to nearly 12 fewer deaths per 100,000 adults each year in expansion states. Just this week, a new study found that Medicaid expansion states also saw reduced rates of postpartum hospitalization. 

Expanding access to the program would also provide coverage for sorely-needed mental health and substance use treatment. In 2019, more than 55% of North Carolinians who needed treatment did not receive it because of the cost, according to the North Carolina Department of Health and Human Services. 

Medicaid expansion would also create tens of thousands of jobs in the state and be a huge boost for rural communities, where hospitals are shuttering and health care is hard to come by. A 2018 study using nearly a decade’s worth of data found that hospitals in Medicaid expansion states were 84% less likely to close than facilities in non-expansion states.

Abortion Rights

Abortion remains legal up to 20 weeks of pregnancy in North Carolina, but in the wake of the US Supreme Court’s decision overturning Roe v. Wade, North Carolina Republicans are gearing up to pass abortion restrictions, including potential bans after 12—or even six—weeks.

Republican House Speaker Tim Moore promised last summer that anti-abortion legislation would be a “top priority of the legislature” when they reconvene in January. 

Gov. Cooper has promised to veto any new abortion bans, but all it would take to override his veto is the absence of two state House Democrats on a vote—or for one House Democrat to support such restrictions, as they did on abortion restriction bills in 2019 and 2019

Education Funding

Another key issue that the General Assembly is likely to act on this year is the state’s public education system, as the legislature must fund years two and three of an eight-year, $5.6 billion school improvement, thanks to a November ruling from the state Supreme Court in the long-running Leandro lawsuit that seeks to improve educational opportunities in low-income school districts.

The Leandro plan aims to provide highly-qualified teachers and principals, invest in high-quality early childhood education such as pre-K and daycare, reduce the focus on standardized testing, and improve pathways from high school to college and career by providing more relevant experience and training. The proposal also calls for improvements to school facilities and better access to school nurses, counselors, psychologists, and social workers.

The improvement plan requires $1.75 billion in new funding during its second and third years, but the state budget lawmakers approved last year provided only about half that amount, according to estimates. 

North Carolina Democrats support the plan, and Gov. Cooper has worked to try to get it fully funded and implemented, but as North Carolina Policy Watch has reported, Republicans claim that schools are already adequately funded and argue that the court does not have the authority to force the legislature to fund the Leandro plan. 

A new set of hearings is expected to take place this year that will establish how much the legislature needs to spend to comply with the court order. Most recently, the State Board of Education unanimously approved a motion calling on the General Assembly and Gov. Cooper to fully implement the court-ordered Leandro spending plan. 

Democracy

In what will feel like deja vu to those who pay close attention to the legislature, Republicans will once again draw new district lines for congressional and state Senate districts this year, due to a ruling last year from the state Supreme Court. Given the North Carolina GOP’s long history of partisan gerrymandering—which occurs when a political party draws or redraws the boundary lines of congressional and state legislative districts in such a way as to maximize the number of seats they hold—it’s likely that 2023 will see new, lopsided maps. 

This process could result in a heavily-gerrymandered map that helps Republicans effectively rig the state’s congressional lines to win as many 10 of the state’s 14 congressional seats, instead of the current 7-7 split. 

Since Republicans won control of the state Supreme Court in November, a newly gerrymandered map is also less likely to be overturned by the state’s highest court, which means that the state GOP may well succeed in its efforts to entrench Republicans’ power and make themselves less accountable to voters.

Medical marijuana

2023 could also be the year that North Carolina joins 38 other states in legalizing medical marijuana. The Senate passed a bill last year that would have legalized medical cannabis, though it would have been highly regulated, allowing doctors to prescribe marijuana only to people with severe conditions, such as cancer, epilepsy, HIV, Parkinson’s disease, post-traumatic stress disorder, and a handful of other serious ailments. 

Under the proposed legislation, the Medical Cannabis Production Commission would have been allowed to issue only 10 medical cannabis supplier licenses, with each supplier being allowed to operate no more than four medical cannabis retail shops. The House failed to pass the bill, however. It’s unclear whether there’s appetite to try again in 2023, but cannabis lobbyists have signaled that the bill remains a priority.

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