GOP controls NC House votes to expand Medicaid

North Carolina House Speaker Tim Moore speaks with reporters about a House Medicaid expansion bill in his legislative office Wednesday evening, June 22, 2022.

North Carolina House Speaker Tim Moore speaks with reporters about a House Medicaid expansion bill in his legislative office Wednesday evening, June 22, 2022.

Echoing arguments Democrats have made for years, Republicans in the North Carolina House of Representatives voted on Tuesday to move forward with expanding Medicaid under the Affordable Care Act.

But differences between the NC House and Senate could still prevent the expansion from becoming law.

A key House committee approved a bill on Tuesday afternoon that was supposed to be presented almost immediately for a formal vote in the House – but was withdrawn at the last minute to correct the wording of some technical problems, said the NC House Speaker Tim Moore, who is personally pushing for the bill and said he thinks it will pass once it comes to a vote.

“I see the federal funds that are available, that our citizens are paying and not coming back, are going to other states,” said Moore, a Republican from Cleveland County.

It’s the same argument Democratic Gov. Roy Cooper made for expanding Medicaid when he became governor five years ago.

“Right now, taxpayers’ money from North Carolina is going to Washington, where it’s redistributed to states that have expanded Medicaid,” Cooper said in a January 2017 speechjust a few days after taking the oath.

It marks a sharp about-face in the legislature, where GOP leaders have spent years battling Medicaid expansion while Cooper and legislative Democrats have made it one of their top priorities. But after national Republicans’ failure to repeal Obamacare, as well as a growing push by leaders in rural communities who would benefit from expanding Medicaid — from hospitals to county governments and more — local Republicans have now accepted the idea.

Two Strategies for Medicaid Expansion

However, the bill introduced in the House would not immediately authorize the expansion of Medicaid. Instead, there would be a study, scheduled for December, after which a final vote would take place.

It’s a different strategy than Republican leaders in the North Carolina Senate have advocated. The Senate passed a Medicaid expansion bill weeks ago that would immediately authorize it, providing health care coverage to more than half a million North Carolinas who cannot afford a private health insurance but who are also not poor enough to qualify for Medicaid under current rules.

“If there is one person in the state of North Carolina who has spoken out against Medicaid expansion more than I have, I would like to meet that person,” Senate Leader Phil Berger told reporters when he has publicly spoke out in favor of expanding Medicaid last month. “Actually, I’d like to talk to this person about why my perspective on this has changed.”

A hypothetical example of a person who is unlikely to have health insurance unless Medicaid is expanded, which Berger and others have repeatedly cited, is that of a single mother with two children who earns about $15 an hour at a job that doesn’t offer benefits.

Hospitals and doctors choose sides?

In addition to wanting to move faster than Republicans in the House, Republicans in the Senate also added several non-health care policy changes that would bring major changes to the multi-billion dollar health care industry. .

These changes include the SAVE Act to lift a set of regulations on nurses; a partial repeal of “certificate of need” laws that limit the expansion of medical facilities; and expanded telehealth rules. Some of these pieces are backed by free market advocates or lobby groups representing business and nurses. However, some are opposed by other pressure groups representing doctors or hospitals.

The House version of the Medicaid expansion bill, by contrast, has none of these additional changes. He has Medicaid only. And on Tuesday, in a committee hearing just before the final vote, top representatives of the state’s medical groups came out to make it clear that they enthusiastically support the House version of the bill, a stark contrast to the chilling reception they gave to the Senate version.

Moore called for representatives of these groups to come to the committee and be recognized.

“We’re very pleased” with the House version of the bill, said Chip Baggett, CEO of the NC Medical Society, which represents physicians.

Steve Lawler, CEO of the NC Healthcare Association, which represents hospitals, also spoke in favor of the bill on Tuesday.

“If you represent a rural community, chances are your hospital is in trouble right now,” Lawler said. “It’s a way of making sure that we stabilize our rural hospitals.”

For more on North Carolina government and politics, listen to the Under the Dome political podcast from The News & Observer and NC Insider. You can find it at or wherever you get your podcasts.

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Will Doran reports on North Carolina politics, particularly the state legislature. In 2016 he started PolitiFact NC, and before that he reported on local issues in several cities and towns. Contact him at or (919) 836-2858.

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