In a shift, top NC Republican is open to discussing Medicaid expansion
North Carolina Republicans are sending the same public signals they do every year about the prospect of expanding health insurance to some of the state’s poorest residents: It’s not happening.
Behind closed doors, however, North Carolina’s most powerful Republican is willing to negotiate the issue with the state’s Democratic governor, conservatives told The News & Observer.
Republican Senate leader Phil Berger has said for years — and reiterated as recently as Wednesday — that Medicaid expansion is bad policy. But Berger is “open to discussion” on the issue this year, said Republican state Sen. Danny Britt, of Lumberton.
That shift comes as the federal government is offering new incentives to North Carolina if it expands health insurance to hundreds of thousands of poor people. Doing that now could mean $1.7 billion in federal funds for the state — an offer that some Republicans don’t want to turn down.
The Senate leader’s willingness to keep all issues “on the table” in this year’s negotiations process means that, for the first time since Cooper became governor, North Carolina could have a state budget backed by both the executive and legislative branch. It also signals that some conservative priorities, like corporate tax cuts, may be included in the final spending package in exchange for Medicaid expansion.
“Medicaid expansion and tax cuts are probably going to be at odds with each other, and that’s something we’re talking through,” said Rep. Jason Saine, a Lincolnton Republican and top House budget writer.
Medicaid is public health insurance for the poor administered by states and the federal government. Expansion would mean the state opts to extend health care coverage to as many as 500,000 low-income North Carolinians, according to some estimates.
The chamber Berger leads has also proposed a spending plan that includes two provisions that would expand Medicaid coverage in small, but still significant, ways. Britt cited those measures as an indicator that Berger is open to considering a broader form of expansion in this year’s budget.
“Based on that, you could assume (Berger has) at least loosened up some and is willing to have discussions about some form of expansion,” Britt said.
This final phase of negotiations between the governor and the Republican-controlled legislature is also playing out as a handful of red-leaning county commissioners in Western North Carolina pass resolutions backing Medicaid expansion — a sign that a growing number of Republicans support the once deeply controversial policy.
If county commissioners continue to pass resolutions, as they are expected to in the coming days and weeks, that could pressure Republican lawmakers to back Medicaid expansion, too.
Dale Wiggins, a Republican and Graham County commissioner, has championed expansion and been a part of the recent effort to encourage other western counties to pass resolutions.
If Berger has a good reason for not expanding Medicaid, “I haven’t seen it,” Wiggins said.
“Everything I see coming from him or about him is the same old argument: ‘We can’t afford it,’” Wiggins said. “Well, all of that’s been answered, all of that’s been dealt with, so he needs to either move it forward in the Senate or he needs to come up with a different excuse, because the one he’s using now he’s kind of worn out.”
Change in Phil Berger’s approach
It’s unclear if Berger’s slight shift in approach to this year’s budget discussions means Medicaid expansion will actually be included in whatever spending plan the legislature ultimately passes.
But Cooper is expected to propose that Medicaid expansion be included in this year’s spending package as he meets with the House speaker and Senate leader in the coming days. And unlike in previous years, Berger hasn’t made the issue a nonstarter this time.
“As I think has been clear all along, there are no totally off-base conversations,” Berger said Wednesday. “I think there are a lot of things that have changed, as far as the approach.”
House Speaker Tim Moore has made no indications he’s willing to negotiate the issue at all, however.
“I’ve seen how that movie ends, and you can quote me on that,” he told The News & Observer Wednesday.
Lawmakers have been willing to consider some smaller changes to Medicaid, Moore has noted.
“But as far as the blanket (Medicaid) expansion that we know has been pushed by some, I do not see that as something that’s really being talked about right now,” Moore told reporters Sept. 29. “I mean besides kind of seeing where everybody is on that.”
Still, Saine said that two topics being negotiated as part of budget talks between the governor and the legislature are tax cuts, which Republicans favor and the governor doesn’t, along with Medicaid expansion.
2019 budget showdown
The rhetoric surrounding budget talks and the topic of Medicaid expansion this year is far tamer than in 2019.
The full version of Medicaid expansion championed by Cooper and Democrats stood virtually no chance at being included in the state budget that year. When the legislature did not include expansion in its proposal, Cooper vetoed their budget, even though the Berger-led Senate said it would support a special session dedicated to considering expansion and other health care issues if a budget agreement was hashed out first.
Berger said at the time that in talks with Cooper, “it was clear that there was nothing that could be done as far as budget negotiations moving forward unless there was an agreement that Medicaid expansion was either part of the budget, or passed in advance of the budget,” The News & Observer reported.
At the time, Berger said expanding Medicaid could increase pressure on other budget items, even with the federal government paying 90% of the cost, and would cover mostly able-bodied adults between 18 and 50.
Republican state House members advanced a bill fully expanding Medicaid with some restrictions that year, but the legislation ultimately stalled.
“We were always willing to find solutions,” said Republican House Majority Leader John Bell, of Goldsboro. “When the governor came out with Medicaid-or-nothing, that kind of ended the conversation before it got started.”
Some Republican House members who championed a form of expansion in 2019 have since left the legislature or now serve in the Senate, leaving a much smaller crowd of Republicans open to the idea of expansion in the House this year.
“I do support Medicaid expansion,” said Sen. Kevin Corbin, a Republican from Franklin, who co-sponsored the House’s 2019 expansion bill. “As far as whether we’re going to move ahead with that discussion, I don’t know. I hope we do.”
Almost all of the county commissioners in Corbin’s district have passed resolutions supporting Medicaid expansion.
Forms of Medicaid expansion
In recent months, the state Senate has advanced two bills that expand Medicaid in some form — another indication that full expansion, with some restrictions, could be in the cards this year.
One bill, if signed into law, would let parents whose children are temporarily taken into state custody still qualify for Medicaid. That bill has since stalled.
The other proposal, which has received more attention both inside and outside the legislature, would extend Medicaid coverage to parents for 12 months after childbirth, up from 60 days. Both measures were included in the Senate’s budget proposal, signaling that they’re a major priority for the chamber.
Postpartum Medicaid expansion is expected to make it into the legislature’s final budget proposal that it will send to Cooper to sign, as both chambers appear to support it.
“There is hope and a possibility of maybe doing more,” beyond that, though, Britt said.
What are the federal incentives?
Sweeping legislation, known as the American Rescue Plan, signed into law by President Joe Biden earlier this year would give North Carolina additional incentives if lawmakers opt to expand Medicaid.
The federal government would cover 90% of the cost if North Carolina extended health care coverage to residents making up to 138% of the federal poverty line, or around $26,500 annually for a family of four.
In addition to that, now, the government would provide an additional 5% match rate for two years, an incentive that the Kaiser Family Foundation estimates would more than cover the cost of expanding coverage here and mean a net of $1.21 billion for North Carolina.
One Senate Health Committee chair, Sen. Jim Burgin, a Republican from Angier, said he still has some concerns about impact on the state’s economy, but remains open to the idea.
“If we could do Medicaid expansion so that there were some limits on it, I think a lot of people would say, yeah, because all of us want people to have good health,” Burgin said. “I think there’s a pathway to probably get there.”
Democrats are also considering whether to force states that have not yet expanded Medicaid to do so, as part of Biden’s $3.5 trillion social policy legislation.
Because the Senate and the House have agreed on a budget proposal to take to Cooper, Berger, Moore and Cooper are expected to work on an agreement that the legislature can pass and the governor can sign. Whether or not Medicaid expansion will be included in the budget as a result of those negotiations should become clear soon.
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This story was originally published October 6, 2021 at 5:05 PM with the headline "In a shift, top NC Republican is open to discussing Medicaid expansion."
