Highlight on North Carolina: New governor forges ahead with Medicaid expansion plans

Newly elected North Carolina Gov. Roy Cooper (D) recently announced that he will take executive action to expand Medicaid in defiance of a state law. The governor’s plans will certainly set up a confrontation with the Republican-dominated state legislature. In an address at an economic fourm, the governor said he would file an amendment to the state Medicaid plan by week’s end. Under the governor’s proposal, North Carolina would allow hundreds of thousands more people to sign up for health insurance.

North Carolina has roughly two weeks to expand Medicaid, as described in the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), and have the plan be approved by federal officials. With President-elect Trump soon to take office, there is no guarantee that Medicaid expansion under the ACA will continue. The North Carolina legislature has refused to expand Medicaid, going as far as passing legislation in 2013 that barred the executive branch from expanding the program. Gov. Cooper has argued that the legislation undermines the executive branch in its “core” responsibility of ensuring the “health of the people.”

Republican state lawmakers disagree, equating any Medicaid expansion as a tax increase. Gov. Cooper noted that Medicaid expansion could boost the economy, as the billions in monies from the federal government would benefit up to 650,000 residents. North Carolina’s share of Medicaid expansion cost would be about 5 percent, rising to 10 percent by 2020. The governor is encouraging the state’s hospitals to cover the state’s share of Medicaid expansion cost. North Carolina’s Medicaid has been in the black for the past three years. In 2015, state lawmakers and the previous governor agreed to rework the system, replacing a fee-for-service structure with one in which insurers receive a fixed monthly amount to care for patients.