With much fanfare, North Carolina expanded Medicaid earlier this year, giving Democratic Gov. Roy Cooper a signature accomplishment and marking a dramatic turnaround for the Republican-led state legislature.
Lawmakers touted the benefits of expansion, including providing health care access to more than 600,000 North Carolina residents and billions from the federal government, perhaps to be used for mental health care.
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But expansion was tied to passage of North Carolina's budget, a maneuver that gave Republicans in the legislature even more leverage over the financial package that has been a source of friction between branchs for years. In order to get expansion in place, his No. 1 priority, Cooper would likely have to sign a budget filled with provisions he disliked.
He hasn't yet had to make that decision because House and Senate Republicans — with veto-proof majorities in both chambers — have not yet reached a compromise on the budget. Each chamber passed their own version and are working to reach agreement.
The start of the fiscal year was July 1. Lawmakers are not expected to return to business until next week, and Senate leader Phil Berger, R-Rockingham, said "probably the earliest" that a vote on the budget would be taken is the week of July 24.
Other major new laws, such as tighter restrictions on abortion access, became law on July 1.
“Making Medicaid Expansion contingent on passing the budget was and is unnecessary, and now the failure of Republican legislators to pass the budget is ripping health care away from thousands of real people and costing our state and our hospitals millions of dollars," Cooper said Monday in a statement. "Tying it to the budget is tying our hands, and the legislature should decouple the two and start Medicaid Expansion now."
Cooper signed the legislation into law on March 27, though he opposed budget provision.
In his statement, Cooper said about 9,000 North Carolinians will lose Medicaid coverage that would have been able to keep it under expansion. He said the delay could cost hospitals money, and the state’s Department of Health and Human Services said previously that expansion means $500 million per month for the state.
It's been three full months since the bill was signed.
“Medicaid is a substantial portion of the annual state budget and shouldn’t be separated for the Governor’s political expediency," Berger spokeswoman Lauren Horsch told WRAL. Legislative leaders are making good progress on budget negotiations, and we look forward to Gov. Cooper swiftly signing the budget.”
North Carolina will become the 40th state to expand Medicaid, which was part of the 2010 Affordable Care Act.
The General Assembly convened in January, and in the spring the House and Senate approved competing budget bills. While they were in agreement on bottom-line spending numbers — $29.8 billion for the next fiscal year and $30.9 billion for the year ending in June 2025 — they differed in the details in a host of areas.
The shape of a tax-reduction package remains a key sticking point, as well as how billions of dollars in proposed reserves will be distributed for items such as capital projects, economic development and emergency savings, Republican officials confirmed this week.
“There were some pretty big differences there,” House Speaker Tim Moore told reporters last week. “What I can tell you is that we are getting closer, but we still have a ways to go.”
On taxes, the Senate budget went much farther to reduce individual income tax rates than the House's version.
The current fiscal year ends next Friday, but there's no threat of a government shutdown without a replacement budget because state law keeps agencies operating at base spending levels.
Medicaid expansion, however, is being held up.
— Information from the Associated Press was used in this report.