Many opponents of Medicaid expansion in NC have changed their minds, but not all

The Medicaid expansion agreement announced by GOP legislative leaders Thursday represents a significant shift in the state’s recent political history.

Next week will mark 10 years since then-Gov. Pat McCrory signed into law a bill passed by the Republican-controlled General Assembly that rejected the Affordable Care Act’s option of expanding Medicaid. A decade later, after many Republicans have come around on the idea, Senate leader Phil Berger and House Speaker Tim Moore say they’ve reached a deal to move forward with expansion.

Still, there are some in conservative politics who continue to have reservations about expansion.

Donald Bryson, president of the John Locke Foundation, has opposed Medicaid expansion for years, and has significant concerns about the agreement Berger and Moore announced Thursday.

Adding roughly 500,000 North Carolinians to the Medicaid rolls without increasing hospital access is irresponsible, and could lead to longer wait times for existing Medicaid patients, Bryson said in an interview.

“It’s similar to giving people car insurance but not providing a way for them to get gas in their car,” Bryson told The News & Observer.

The agreement does include elimination of certificate of need requirements for certain medical services, intended partly to make it easier for hospitals to purchase new equipment without the state’s approval. But it doesn’t fully repeal the state’s CON law, as some Republicans have proposed.

Bryson also took issue with the federal funds that North Carolina stands to receive if it expands Medicaid.

If the expansion deal passes, the state would get billions of dollars from the federal government — around $8 billion to the state annually for the program, plus $1.8 billion that can support a variety of other needs, according to the state Department of Health and Human Services.

Republican leaders have touted the funds as a major selling point, but Bryson disagreed, telling the N&O that the funds were “deficit spending” that would hurt the state’s reputation for fiscal responsibility.

“It’s taxpayer money — it just happens to come from the federal government and not state,” Bryson said on Twitter. “Let’s not act like this is a fiscally conservative stance.”

Robinson has opposed Medicaid expansion

While Republicans may be able to pass expansion, one of the party’s leading voices has been opposed.

Lt. Gov. Mark Robinson, the presumed frontrunner for the GOP nomination for governor in 2024, has said he doesn’t think the state should expand Medicaid.

In September 2022, Robinson told Business NC that he wasn’t in favor of expansion and hoped the effort to expand Medicaid failed, because he didn’t want health care in the state “to be turned over to the federal government.”

“We have enough talented people in North Carolina that we can come up with our own healthcare system that would be far better than anything the federal government can provide in Medicaid expansion,” Robinson told the magazine.

The N&O reached out to Robinson’s office on Thursday to ask if he had discussed the agreement with either Berger or Moore, and if he remained opposed to expansion, but did not hear back from a spokesperson in time for publication.

Some holdouts in the legislature too

Nearly two dozen Republicans in the House also remained opposed to expansion, at least the version laid out in a bill that advanced last month and passed the House in a broad, bipartisan vote.

That bill is different from the agreement announced Thursday, and it’s possible the new agreement between the two chambers addresses some of the concerns held by the remaining GOP holdouts.

Henderson County Rep. Jake Johnson, who was one of 23 Republicans to vote against the House’s Medicaid expansion bill last month, said the outline of the new agreement “certainly addresses some of my main concerns.”

“I look forward to reviewing the details to make sure we are not deterring able body adults from entering or reentering the workforce when small businesses are already struggling to find employees,” Johnson said in an email.

Most of the other Republicans who voted against the House bill didn’t respond to requests for comment. Some who did said they hadn’t yet seen the agreement.

For more North Carolina government and politics news, subscribe to the Under the Dome politics newsletter from The News & Observer and the NC Insider and follow our weekly Under the Dome podcast at campsite.bio/underthedome or wherever you get your podcasts.