Primary Opposition

The main opposition to the legislation came from those opposed to the idea of expanding coverage to families at more moderate incomes and/or concerns about "crowd out". The significant cost sharing that was included in the original Carolina Cares for Children proposal was cited to counter some of the opposition. However, the component of the original Carolina Cares for Children proposal that would have allowed families above 300 percent of the federal poverty level (FPL) to buy into the program at the full cost was not included in NC Kids’ Care, primarily due to the opposition concerns about crowd-out.

Some of the opposition to covering higher income families was also limited by support by members of the small business community who were able to speak out about the importance of having such a program to help them meet the needs of their employees.

Strong leadership and support from the North Carolina provider community also may have helped offset any concerns about access. Unique to North Carolina is that provider reimbursement for its Medicaid, Health Choice (and eventually) NC Kids’ Care programs is similar to Medicare rates. This is not the case in many states, where concerns about access (due to low provider reimbursement rates) have the potential to deter or derail expansion efforts. Because North Carolina’s publicly funded programs are well regarded by the provider community, their support and leadership for NC Kids’ Care was strong throughout this effort.