N.C. Governor Tries to Sneak a Medicaid Expansion Under the Wire

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The new Democratic governor of North Carolina has less than two weeks to get a Medicaid expansion approved by the Obama administration. Photo: Robert Willett/AP

Roy Cooper did not get off to what you’d call a great start as governor of North Carolina. He had to wait weeks for confirmation of his election, thanks to challenges to the results by the incumbent Republican he defeated, Pat McCrory. And then, two weeks before he took office, the Republicans who control his state’s legislature took advantage of a special session called for flood-relief measures to whip through several bills stripping the governorship of several previously established powers.

So now that he’s in office Cooper is trying to flex his own muscles by adding North Carolina to the list of 31 states that have accepted the Medicaid expansion authorized by the Affordable Care Act.

Cooper is really trying to thread a needle here. Approval of his state’s Medicaid expansion application would have to happen by January 20, assuming (as is safe to assume) the Trump administration will at the very minimum put up a caution light on expansions if it does not succeed (with Congress) in shutting them down entirely and perhaps repealing those currently in place. He needs some commitments from hospitals and other providers to come up with the relatively small but crucial non-federal match needed to make an expansion happen, since the legislature isn’t going to appropriate it. And there are notice requirements in state law that have to be satisfied.

GOP legislators are livid about Cooper’s efforts; he’s disregarding as unconstitutional a state law passed earlier that prohibits any gubernatorial initiative to expand Medicaid. Even if Cooper and HHS can somehow get it all done before Donald Trump takes the oath of office, there will be litigation to try and stop or reverse the expansion.

But Cooper figures it’s worth the gamble if there’s even a remote chance of covering over a half-million North Carolinians who might qualify for Medicaid under the expansion. And for all we know, states that did choose to expand (including Vice-President-elect Pence’s Indiana) may be privileged in any post-Obamacare-repeal scheme, and will certainly be in a better position if congressional Republicans cannot get their act together to repeal Obamacare at all.

NC Governor Tries to Sneak Medicaid Expansion Under the Wire