More than 600,000 residents of North Carolina will gain access to health insurance starting today thanks to the expansion of the state’s Medicaid program.
Since his election in 2016, Democratic Gov. Roy Cooper has pushed to expand the health insurance program for low-income households, as allowed under the Affordable Care Act, known more popularly – and in some cases, disparagingly – as Obamacare.
Cooper approved the expansion in March, but Republicans in the North Carolina legislature fought its implementation, passing a rule that required the state to approve a 2024 budget before the expansion could take effect and then dragging budget negotiations into September.
Cooper opposed the final budget but allowed it to become law without his signature, in part to allow the expansion to occur. “Make no mistake, overall this is a bad budget that seriously shortchanges our schools, prioritizes power grabs, keeps shady backroom deals secret and blatantly violates the constitution, and many of its provisions will face legal action,” Cooper said in September. “However, we must recognize this irresponsible legislature’s decade of refusal to expand Medicaid, which has caused life and death situations for so many North Carolinians and threatened the very existence of numerous rural hospitals.”
Ongoing battle: States were given the option to expand their Medicaid programs starting in 2014, but some have refused to do, with many citing fiscal concerns, though critics have charged that some Republican-controlled states, many in the South, are simply opposed to providing services for the poor.
The expansion raises the threshold for eligibility to include households earning up to 138% of the poverty line and removes a disability requirement. For a single person, that raises the income threshold from $14,580 to $20,120 per year, while a family of four sees its limit rise from $30,000 to $$41,400. Under the terms of the expansion, the federal government picks up 90% of the cost. The American Rescue Plan of 2021 provided an additional 5% of cost coverage in the first two years, a bonus that played a role in the expansion’s success in North Carolina.
There are now 10 states remaining that have refused to expand their programs (see the map from KFF below). As The Hill’s Nathaniel Weixel notes, all 10 states have a Republican governor, a Republican-controlled legislature, or both.
In a statement, the White House applauded Medicaid expansion in North Carolina while warning about Republican efforts to undermine the healthcare law that made it possible. “Every American deserves high-quality affordable health care. Today, we are one step closer towards meeting that promise, as 600,000 North Carolinians can now access the affordable, quality coverage they need under Medicaid,” President Joe Biden said. “Despite this progress, MAGA Republicans still want to get rid of the Affordable Care Act, just like my predecessor tried and failed to do repeatedly. There are 40 million people who get their health insurance through the Affordable Care Act and repealing the law would put their care at risk.”