Medicaid expansion will launch Dec. 1 in North Carolina, Gov. Roy Cooper announced on Monday after achieving what he's sought for nearly seven years on the job and what's possibly his biggest policy win.
Government health insurance should be available to another 600,000 low-income adults, with roughly half of them receiving coverage on Day One. But securing expansion through the Republican-controlled state legislature came with hefty political expenses for the Democratic governor that will be difficult to reverse.
Still, Cooper celebrated the influx of billions of dollars from the federal government that he says will boost rural hospitals, create jobs and help those suffering with pain and illness that they can't otherwise afford to treat because they are uninsured.
"This has been an unnecessarily long and agonizing journey for many North Carolinians," Cooper said at an Executive Mansion news conference with health Secretary Kody Kinsley to reveal the start date. "But today, the hope that has stirred in so many across our state will become a reality."
Cooper said he and Kinsley have talked to federal officials and that a potential government shutdown in Washington shouldn’t delay the Dec. 1 start date.
A landmark bipartisan Medicaid law that Cooper signed in March removed North Carolina from the list of 11 states that at the time hadn’t accepted expansion. The law required a budget to be approved before expansion could be implemented.
Republicans with narrow veto-proof control of the General Assembly piled provisions inside that spending plan, unveiled last week, which weaken Cooper and future governors to the benefit of the General Assembly.
North Carolina Gov. Roy Cooper, right, speaks while state Health and Human Services Secretary Kody Kinsley listens at a news conference in Raleigh on Sept. 25, 2023. Medicaid expansion, supported by Cooper, will finally cover thousands more residents starting Dec. 1. (AP Photo/Gary D. Robertson)
Cooper also had to stomach other policy prescriptions within the budget bill, such as a massive enlargement of the state's private-school voucher program to all K-12 children regardless of family income.
It appeared Republicans had enough support to override any Cooper veto. Rather than signing the budget bill into law, Cooper announced minutes after it received final legislative approval on Friday that he would let the bill become law without his signature. That means the budget should be enacted Oct. 3.
"I know there’s a lot of bad in the budget that they passed," the governor said, but "in this legislative circus we can’t take any more chances on delay or defeat with the lives of so many people at stake."
A state budget was supposed to be in place July 1, but it took 2 1/2 more months to finalize as negotiations slowed among Republicans over income tax reductions and the distribution of billions of dollars for capital improvements, economic development and other areas. A stalemate over whether more gambling should be authorized also briefly threatened whether a budget would get approved.
The state Department of Health and Human Services had said expansion would've started Oct. 1 had a budget been completed by the end of August.
Through expansion, adults age 19-64 get coverage even if they make too much to qualify for traditional Medicaid but too little to receive even heavily subsidized private insurance. For example, a single person who makes up to about $20,000 or someone in a family of three that makes $34,000 would benefit.
Nearly 2.9 million people are currently enrolled for Medicaid in North Carolina. Kinsley, the health secretary, said roughly 300,000 people who participate in a limited Medicaid program for family planning benefits and who meet income requirements will automatically be registered for full Medicaid benefits.
Additional recipients will accumulate as people learn about the expansion and county social service offices enroll them, Kinsley said.
To those who'll benefit from expansion, Kinsley said, "I have one final message: We’ve got you covered."
Within days of taking office in January 2017, Cooper tried to get expansion initiated before the Obama administration ended. But a 2013 law required express approval of the General Assembly before expansion could be sought, and a federal court blocked Cooper's efforts.
Cooper vetoed the state budget in 2019 because legislative leaders wouldn’t commit to Medicaid talks. That led to a protracted impasse and a traditional state budget was never approved that year.
"I don’t regret a single attempt to expand Medicaid because I think it has led us to this day," Cooper said Monday.
By mid-2022 both the House and Senate had passed competing expansion measures.
Top Republican leaders said they changed their opinion on expansion because traditional Medicaid was on firmer fiscal ground compared to the early 2010s. They were also attracted to a financial bonus for the state from Congress should North Carolina accept expansion. Hospital leaders, Republican sheriffs and county GOP officials also lobbied them to accept expansion.
President Joe Biden acknowledged on Monday the expansion accomplishment in a written statement, praising "bipartisan elected officials" as well as Cooper, whom he cited for "years of leadership fighting to get this monumental step forward for North Carolina families done."