Medicaid expansion has been a stumbling block in North Carolina politics. It’s derailed state budgets and has long frustrated Democratic leaders.

The governor vetoed earlier budgets because the Republican-controlled legislature refused to include expanded Medicaid coverage. This year’s budget, the first the governor has signed in years, includes a provision to study expanding Medicaid coverage to more people in North Carolina.

“I’m still deeply disappointed that we have yet to expand Medicaid, particularly in the middle of a pandemic, particularly when you have more than a million of North Carolinians without health insurance,” Gov. Roy Cooper said in an interview with Spectrum News 1’s Capital Tonight.

What You Need To Know

  • North Carolina is one of 12 states that has not expanded Medicaid coverage

  • The new state budget includes provisions for a General Assembly committee to study potentially expanding Medicaid to hundreds of thousands of adults in North Carolina

  • Gov. Roy Cooper vetoed the Republican-led General Assembly's budget in 2019 because it did not include Medicaid expansion, but he did sign this year's budget

  • Speaking on Spectrum News 1's Capital Tonight, Cooper said he was hopeful the state could pass expanded Medicaid in 2022, but it will really be up to Republicans in the legislature

He said Democrats and Republicans got very close to including it in this year’s budget, but it ultimately did not make it through the final negotiations.

Thirty-eight states and Washington D.C. have opted to expand Medicaid since Congress voted to send more money to states to cover more people under the health care program, according to the Kaiser Family Foundation, which studies health care issues.

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“It is probably the most frustrating part of my time as governor that North Carolina has not yet made this very basic, smart decision to draw down those federal dollars,” Cooper said.

“The state of Oklahoma voted for Medicaid expansion, Utah voted for it, Missouri voted for it. These are red states,” he said.

An expanded Medicaid program could give health insurance coverage to more than 370,000 adults in North Carolina, according to the Kaiser Family Foundation.

The new budget creates a legislative committee to study access to health care next year and recommend a bill. Some Republicans in the General Assembly are still resistant to a full Medicaid expansion.

“We’ve agreed to at least study the issue, but study the issue more broadly. What kind of policies will result in more access to affordable health care?” said Rep. John Hardister, a Greensboro Republican and the majority whip in the North Carolina House.

“Personally, I’m not a fan of blanket Medicaid expansion, but I’m interested in certain areas where we can expand services, such as people who have a bonafide disability, can we do more to help veterans,” he said in an interview with Spectrum News 1.

Hardister said he is interested in seeing if the state can expand services for substance abuse and mental health issues in the state.

“As far as a plan for Medicaid expansion, that’s not something we’re talking about right now. But it will continue to be discussed simply because the governor is very adamant about expanding Medicaid,” he said.

Congress first passed Medicaid expansion in 2014 as part of former President Barack Obama’s Affordable Care Act. The ACA, also known as Obamacare at the time, paid states 90% of the bill for expanding Medicaid to more adults.

A stalemate between Cooper and Republican leaders in the General Assembly in 2019 meant the state never passed a full budget.