Behind the scenes of N.C.'s Medicaid expansion battle

Context: The ads come just weeks after the Senate passed a bill that would expand Medicaid.

• The bill also includes numerous provisions — some controversial — that could expand access to health care in the state.

The latest: The legislation has since stalled in the House, where it has less support among Republicans.

• House leaders have repeatedly said there's not an appetite to take up the legislation before the session is slated to end later this month. Many Republicans in the chamber also oppose other non-Medicaid provisions included in the proposal.
• In recent weeks, however, there's been growing energy among House Republicans to work to find a solution.

Why it matters: The newly released ads threaten that momentum. They're also the latest indicator of the heated internal battle playing out among Republicans inside the legislature, centered around whether — and how — to add some 600,000 to the state's Medicaid rolls.

• "Leader Bell has been clear that he wants to find a bipartisan North Carolina solution that addresses our health care challenges and expands access to care, especially in our rural areas," Bell spokesperson Jimmy Milstead said in a statement.
• Bell also wants House Republicans to have a voice in conversations about Medicaid expansion without interference from outside groups, Milstead said.

Flashback: Physicians and other providers, alongside hospital, insurance and other health care groups, poured money into state primary races last month in an attempt to sway lawmakers to either support or block the legislation.

• Those groups spent at least some $150,000 in one Republican Senate primary between Sen. Ralph Hise, who has played a major role in advancing the Medicaid expansion bill, and Sen. Deanna Ballard, whose campaign was funded in part by groups that oppose it. Hise ultimately won the race.

The big picture: The new cancer society ads also point to a larger trend of outside groups weighing in on the legislation.

• The American Society of Anesthesiologists has been running Facebook ads opposing parts of the bill.
• Last month, text messages from an unknown source were sent out, encouraging North Carolinians to call on lawmakers to vote against the expansion.

Between the lines: It's unclear who is advising the American Cancer Society's action network on the ads, but there have been rumblings in the state capitol that one of Cooper's top advisors is involved.

• Morgan Jackson, a longtime advisor to Cooper, said he was not involved and that the American Cancer Society is not a client of his.
• Medicaid expansion has long been one of Cooper's top priorities.
• One company that bought ads supporting Gov. Roy Cooper's 2020 campaign, which Jackson worked on, advertises on its website that it's done branding work and helped the cancer society launch ads in six states on the topic of Medicaid expansion.

What they're saying: "It's a shame a national organization wants to disrupt these negotiations and seek to divide lawmakers with a false and misleading ad," Milstead said. "Whoever is advising them is giving bad advice."

The other side: "We understand a handful of key House members might be frustrated by being called on publicly to do the right thing now that a clear path has presented itself, but not having access to health care is far more frustrating for the 600,000 North Carolinians who've been waiting for nearly a decade for their legislature to act," Taylor Hall, a media advocacy manager for the American Cancer Society Cancer Action Network, told Axios.

What's next: North Carolina's legislative session is set to wrap up in the coming weeks, and it remains unclear if the House will pass any version of the legislation.

Worth noting: Numerous groups around the state, including the North Carolina Sheriffs' Association and Association of County Commissioners, have released statements in recent days supporting Medicaid expansion.