The North Carolina Senate passed a bill to expand Medicaid, which could extend health care coverage to hundreds of thousands of people in the state. The bill now heads to the House. It's not clear if House Republicans will be as receptive to the bill as their Senate colleagues.

The Republican-controlled General Assembly has resisted calls to expand Medicaid for more than a decade since Congress passed the Affordable Care Act, commonly called Obamacare.

What You Need To Know

  • The North Carolina Senate passed Medicaid expansion Thursday, sending the bill to the House

  • It's not clear if Republicans in the House will be as receptive to expanding health care coverage as their colleagues in the Senate

  • Republicans have opposed Medicaid expansion in North Carolina since the 2010 Affordable Care Act gave states the power to add more people to the health care program

  • The program would be budget-neutral, Senate Republicans say, and would add hundreds of thousands of people to Medicaid in North Carolina

“We must do something to improve health care, especially expand access and lower costs,” Senate Pro Tem Phil Berger said when he introduced the bill May 25. “We need coverage in North Carolina for the working poor.”

Berger, a Republican, has been one of the most vocal critics of Medicaid expansion in North Carolina. But he's changed his tune.

“Medicaid expansion has evolved to a point where it is now good fiscal policy,” he said. The federal government covers 90% of the bill, and Berger said he's now convinced that Congress won't go back on that promise.

The Senate bill, titled "Health Care Works," would give Medicaid coverage to up to 600,000 more people in North Carolina. It would cover people who make 138% or less of the federal poverty level. That's $18,754 for a single person or $38,295 for a family of four. 

All but 11 states have expanded Medicaid since Obamacare was passed a dozen years ago.

Last year, the federal government added another incentive to get the last holdout states to extend health care coverage. A 2021 COVID relief package offered $1.5 billion to North Carolina over two years to treat existing Medicaid patients if the state expands coverage.

The expansion would be budget neutral, with the 10% cost covered by a new fee on hospitals.

The bill would do more than expand Medicaid. It also includes provisions doing away with most Certificate of Need rules, which require hospitals to get state approval to add services or build new facilities.The bill would also allow nurses with advanced certificates, like nurse midwives and nurse practitioners, to practice without a doctor's supervision.

With Medicaid expansion approved by the Senate, the House will take up the bill next. Republican House Speaker Tim Moore has not directly said if he supports the bill or not.

The bill moved at near-record pace through the North Carolina Senate, with just eight days from Berger introducing the bill to having it pass a third reading on the Senate floor. And that's with the Memorial Day long weekend in the middle.

The days in the General Assembly's short session are numbered, with legislators aiming to leave Raleigh by the Fourth of July. It will be up to the GOP-controlled House to decide if North Carolina will expand Medicaid this year.