After a yearslong battle to expand Medicaid in North Carolina, the Republican-led state General Assembly approved the policy on a bipartisan vote Thursday.
North Carolina hospitals have supported Medicaid expansion since the Affordable Care Act became law in 2010 with generous federal funding to broaden eligibility for the program. As in other states, the hospital industry sees Medicaid expansion as a means to boost health coverage, reduce uncompensated care and shore up finances at struggling facilities, especially those in rural areas.
The North Carolina bill, which passed the House 87-24 Thursday after clearing the Senate 44-2 last week, garnered the support of all General Assembly Democrats and a majority of Republicans.
Gov. Roy Cooper (D) cheered the result. "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," he said in a news release Thursday.
The legislation includes new assessments on hospitals to finance the state’s share of the expansion’s costs. Hospitals are projected to contribute $550 million a year. The bill also would loosen certificate of needs laws.
The North Carolina Healthcare Association, which represents hospitals, endorsed the proposal and welcomed its passage. “This landmark legislation will have lasting benefits for our state by helping hardworking North Carolina families, stabilizing rural health providers and improving the overall health of our communities,” President and CEO Steve Lawler said in a news release Thursday.
“Medicaid expansion is the single most transformative state policy the N.C. General Assembly can enact to increase access to healthcare and strengthen the primary care safety net,” North Carolina Community Health Center Association President and CEO Chris Shank said in a news release Wednesday following a preliminary House vote on the bill.
An estimated 600,000 North Carolina adults with incomes below 133% of the federal poverty level—$19,391 a year for a single person—would be eligible when the law takes effect.
Under the Affordable Care Act, the federal government finances 90% of Medicaid expansion costs and states are responsible for the remainder. In addition, President Joe Biden enacted a law last year to provide additional short-term funding for states that take up Medicaid expansion.
When Congress passed the ACA, the Medicaid expansion was meant to be national, but the Supreme Court ruled in 2012 that states could opt out. Not counting North Carolina, 10 states have not expanded Medicaid under the ACA.
Objections to supporting “Obamacare” and fiscal concerns stymied previous efforts to advance Medicaid expansion in North Carolina.
The state legislature came close last year when the House and Senate passed Medicaid expansion bills. But the chambers could not reach common ground on the certificate of needs provisions before the General Assembly recessed in July. North Carolina House of Representatives Speaker Tim Moore (R) and Senate President Pro Tempore Phil Berger (R) broke the impasse when they announced a bicameral agreement on March 2.
Even after Cooper enacts the law, he and the legislature have another hurdle to overcome before Medicaid expansion becomes a reality in North Carolina. Lawmakers must include the financial aspects of the expansion policy in a broad budget bill that could provoke disagreements between GOP lawmakers and the Democratic governor over unrelated issues.
This article has been updated to reflect the final North Carolina House of Representatives on the Medicaid expansion bill Thursday and to include comments from Gov. Roy Cooper (D) and the North Carolina Healthcare Association.