NC Medicaid expansion battle: Timeline of Cooper, Berger and Moore moves

If Medicaid expansion passes in North Carolina this year, it will be the end of a yearslong power struggle between the governor, the leader of the Senate and the speaker of the House.

Democratic Gov. Roy Cooper and Republicans House Speaker Tim Moore and Senate President Pro Tempore Phil Berger are the three most powerful politicians in the state. Moore and Berger announced a Medicaid expansion deal had been reached between the chambers on Thursday, and planned to meet soon with Cooper, who has long supported expansion.

But Republicans are tying expansion to passage of the state budget, which also has been at the core of years-long battles between the Democratic governor and Republican legislative leadership.

Cooper, Berger and Moore are the three names at the center of every major decision in the state. And the dynamic between the three men shifts depending on what they are doing. The biggest thing they agree on across party lines is wanting North Carolina to have a thriving economy. And now, so too is Medicaid expansion something they all agree should happen this year.

READ MORE: ‘A monumental step.’ Cooper and Biden praise Republican Medicaid expansion agreement

It wasn’t always that way. Here’s how we got here.

Timeline of NC Medicaid expansion deal

▪ January 2014: States can now expand Medicaid through the Affordable Care Act, which became law during President Barack Obama’s administration. Medicaid is available to people whose household income is below 138% of the federal poverty level. But on March 2, 2013, then-Gov. Pat McCrory, a Republican, signed Senate Bill 4 into law, rejecting Medicaid expansion in North Carolina.

▪ January 2017: Cooper, elected in 2016, takes office. Berger comes out against Cooper’s attempt to expand Medicaid:

“Just days into his term as governor, Roy Cooper already intends to violate his oath of office with a brazenly illegal attempt to force a massive, budget-busting Obamacare expansion on North Carolina taxpayers,” Berger wrote, saying that the governor cannot expand Medicaid without legislative approval.

▪ Summer 2019: Medicaid expansion becomes the sticking point of the state budget battle. Republicans say Cooper gave them a “Medicaid expansion or nothing” ultimatum. Cooper and Republican lawmakers exchange letters about the budget stalemate, which never ends. Instead, a series of small budget bills are passed.

▪ August 2020: At a press briefing during the coronavirus pandemic, The News & Observer asks Cooper about expansion.

“We could do it just like that,” Cooper says, snapping his fingers.

▪ Summer into fall 2021: Medicaid expansion, yet again, is part of budget negotiations. But in October, Moore says that there isn’t enough support to include it as part of a budget deal. The final budget, however, includes a study committee on Medicaid expansion.

▪ November 2021: Key Republican senators acknowledge shifting their stance on Medicaid expansion, including Berger. But the House is still a hold-out. After the budget passes, Moore says that he “never thought that Medicaid expansion was appropriate to be used as a bargaining tool or a trade off point.”

▪ June 1, 2022: The Senate passes its version of a Medicaid expansion bill.

▪ June 22, 2022: Moore says the House will pass its own Medicaid expansion bill, but without what the Senate wants in it. The bill comes as budget negotiations start. But a compromise is not reached, and the 2022 budget, an adjustment to the two-year spending plan passed in 2021, becomes law without Medicaid expansion.

▪ Summer 2022: Cooper remains hopeful that a compromise will be reached. It will not.

▪ September 2022: It looks like a Medicaid expansion compromise between the chambers is imminent. Moore had mentioned to reporters that they could come back into session in December to pass a bill. But with the certificate-of-need law still an issue, that doesn’t happen.

“It’s time to get this done,” Cooper says. “It’s critical that we act right now to pass Medicaid expansion to save lives and secure the $521 million we are losing every single month in federal funding.”

▪ January 2023: The legislative long session begins. Both Berger and Moore say they want Medicaid expansion to pass this session. But they don’t know when.

▪ Feb. 16, 2023: The House passes House Bill 76: Access to Healthcare Options.

▪ March 2, 2023: Berger and Moore announce the two Republican chambers finally have a deal. Cooper calls it “a monumental step.” Berger says the Senate will take HB 76 and add certificate-of-need law changes to it.

What’s next

When Berger, Moore and other Republican lawmakers announced the deal on March 2, there wasn’t a bill to show yet. It will look like the House bill, with changes to certificate-of-need law, they said.

Republicans said that while a new Medicaid expansion bill is coming in the next few weeks, that is just a precursor to it being part of the state budget. The budget is on track, for now, to pass the legislature in mid- or late June and be sent to Cooper to sign, veto or let become law without his signature.

That means the fate of Medicaid expansion is also tied to the state budget. Berger also said that while the House bill would have expansion begin Jan. 1, 2024, that’s still up in the air. Cooper would like it sooner.

If everything falls in place by then, it would be exactly 10 years since states could expand Medicaid. North Carolina is among 11 states that have yet to do so.