We Should All Support Governor Cooper’s Plan to Expand Medicaid in North Carolina


When Medicaid was first enacted in 1965 under President Johnson, it provided health insurance to lower income people, their children, and people with certain disabilities. It is a means-tested program which places a ceiling on income eligibility tied to the federal poverty line. The Affordable Care Act (ACA) was enacted in 2010 under President Obama; it substantially expanded the Medicaid eligibility ceiling and coverage. It covers all citizens up to 138 percent of the federal poverty level including adults without children.

The ACA faced bitter opposition, especially from Republican elected officials. In 2012, the U.S. Supreme Court ruled that the states were not required to follow this mandated expansion and could retain previous Medicaid coverage. Thus it was up to each state to decide whether to expand Medicaid coverage to the ACA mandated levels. As of this date, all but 12 states have done so. North Carolina has not. The Republican leadership in the North Carolina General Assembly has opposed this Medicaid expansion since 2013. So, the problem is, what to do about it.


In his latest budget proposal, Governor Roy Cooper has included his long-time priority, Medicaid expansion for 500,000 North Carolinians without health insurance. The stand-off over Medicaid expansion between Cooper and the Republican-led legislature led to Cooper vetoing the state budget in 2019. “Getting more health care coverage to people in North Carolina is certainly a priority,” he said. “Medicaid expansion is the best way to do that.” In the past year countless numbers of North Carolina workers have lost their jobs and their health care coverage. This makes the issue of expansion more urgent in that the probable number of people who would benefit has climbed.
And just in time, another landmark piece of legislation, the American Rescue Plan (ARP), just recently signed into law by President Biden, provides substantial incentives for holdout states to finally expand Medicaid which, for North Carolina would include these, among other, benefits:

After the enactment of the Families First Coronavirus Response Act the government is now paying close to 74 percent of each Medicaid dollar spent in North Carolina. ARP would increase that even more by adding 5 percent. It is estimated that the boost to the bottom line would be about $1.7 billion while the cost to the state would be a 1/2 billion – a net gain of as much as $1.2 billion for the state.
Moreover, ARP would also provide extra coverage for new mothers for one year to fight pregnancy-related illness and deaths. Currently Medicaid only covers the first 60 days after birth.

We urge readers to contact the NC Senate President Phil Berger and the NC House Speaker Tim Moore and encourage them to work with Governor Cooper to expand Medicaid coverage.

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