North Carolina Republicans reach deal to expand Medicaid

Republican lawmakers in North Carolina say they have reached an agreement on expanding Medicaid in the state.

The deal enacted would remove North Carolina from the small list of states that have not expanded Medicaid under the Affordable Care Act.

North Carolina is one of 11 states that have not expanded Medicaid coverage since the Obama-era law. It is a push that has faced significant conservative opposition in the states where it has not been adopted. 

In North Carolina, Republicans in the House and Senate had agreed on the need to expand the program, but disagreed over how to do so.

The basic disagreement between Republicans in the two chambers was that Senate Republicans wanted to attach to the bill some larger changes to health care regulations in the state, a move that House lawmakers bulked at, according to WRAL News.

Lawmakers said at a press conference on Thursday that some but not all of the regulatory changes sought by Senate Republicans would be in the compromise, including a partial repeal of laws that limit competition in the health care industry.

Both chambers of the North Carolina legislature have strong Republican majorities. The move to adopt the Medicaid expansion comes as the federal government in recent years has added even more incentives for holdout states to adopt it. Under the Affordable Care Act expansion, the federal government pays 90 percent of the costs for states that expand the program.

But the 2021 American Rescue Plan, which is one of the landmark achievements of the Biden administration, sweetened the deal even more for states.

Under that law, the federal government will cover 95 percent of costs for two years for new expansion states, with hospitals and insurers covering the rest. Proponents of expansion in the state see it as a way to help boost the state’s overall health care system, especially rural health care services. 

While lawmakers said they had reached an agreement, it will take until a new budget is passed for the expansion to take effect.