Here’s my prediction for the legislative session: North Carolina will expand Medicaid this year. Roy Cooper is set on it and Republican opposition is concentrated most fervently in the leadership, not the rank and file. It has broad support among the voters and much of the money would go into areas controlled by the GOP. 

At a meeting last week, Roy Cooper’s legislative affairs director, Lee Lilley, said, “Session ends when we get Medicaid expansion.”  That’s quite a line in the sand. Cooper could veto budgets until he gets what he wants, but one house of the legislature will have to stand firm against an override. We’ll find out how much moxie Democrats have. 

Medicaid expansion is a good issue for both parties, really. It has strong support among voters as well as the medical community and hospitals. Going into 2020, both sides could claim they delivered for their constituents. On the flip side, if Republicans oppose it too vigorously, they could find themselves on the bad end of some rough attack adds about denying people medical coverage. Again, people in rural areas and their hospitals stand to benefit.

Cooper won’t get exactly what he wants and we’ll probably hear Republicans describe it as something besides Medicaid expansion. I expect it will take on the term Medicaid “reform” since reforming in Republican terms generally means “cut.” This time it will mean more money but reform will be more politically palatable for the GOP base. Still, it will offer more people health coverage and bring a large infusion of federal money into the state.

Medicaid expansion has pushed aside other issues like ending gerrymandering to become the central focus as the legislature begins its long session. Expanding it is good politics for both sides. They can claim they did something tangible for their constituents. Democrats will claim victory. Republicans will say they’ve done something to help hospitals and brought money into distressed areas. It’s a win-win for everybody except the ideologues.


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