Mar 27, 2023 - News

NC governor signs Medicaid expansion into law

Illustration of a long, winding road with red health crosses painted down the middle as lane dividers

Illustration: Annelise Capossela/Axios

North Carolina is on the last leg of its 12-year journey to extend health care coverage to some 600,000 of our state's working poor.

Driving the news: Gov. Roy Cooper signed legislation Monday that will make North Carolina the 40th state to expand Medicaid, with one major caveat: The legislation isn't effective immediately.

Why it matters: Cooper has been calling on North Carolina's Republican-controlled legislature to expand Medicaid throughout his entire tenure as governor. With the backing of GOP leaders Phil Berger and Tim Moore, he finally succeeded.

  • "Hundreds of thousands of hard working North Carolinians — many with two or more jobs — have suffered in the health care coverage gap while a solution sat just out of reach," Cooper said before signing the legislation. "With this law I'm about to sign, many of them will be close enough to grab it."

But, but, but: Is it ever really that simple?

  • Republicans tied expansion to the budget by including a provision in the Medicaid expansion package that makes it effective when the budget also becomes law.

What's next: The state House is set to unveil its budget proposal this week. The Senate will then roll out its own proposal after that, and leaders in the two chambers will get together to hash out an agreement.

  • Republicans are expected to add proposals to the budget that will be hard for Cooper to swallow.

But Cooper is determined to get expansion across the finish line: "It's only a question of when, and not if," he told reporters Monday.

Fake it 'til you make it: When Medicaid expansion comes up at your next dinner party (because it’s not just Lucille that talks about wonky health care policy over drinks, right?), you’ll sound smart if you say:

  • “Yeah, it’s a big deal that they finally passed it, but now we’ll see if they can get a budget done. They’ve got a long way to go, and I wonder what Republicans will include in the budget now that they have Medicaid expansion as leverage over Cooper.”

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