Midterm Elections Improve Prospects for Medicaid Expansion in North Carolina

The loss of Republican supermajorities in the North Carolina House and Senate in the recent midterms was the first sign of an improving climate for expanding Medicaid in the Tarheel state. Now when Democratic Governor Roy Cooper exercises his veto power, Democrats in the legislature can block legislation – including the annual state budget bill – and start to encourage bipartisan compromise on key issues.  Cooper vetoed 25 bills in his first two years in office and the legislature overrode 20 of them. Now Republicans will need Democratic votes to override a veto, making it more likely that legislation includes more input from both sides of the aisle.

In addition to NC GOP statehouse seat losses was the overwhelming defeat of two state constitutional amendments Republicans put before voters with the purpose of transferring power from NC’s Governor to the legislature. These amendments would have taken away the Governor’s appointment powers both over state judges and over the board that oversees elections. Each was soundly defeated by a large margin of voters, sending a clear message that stripping the Governor of power wasn’t popular with either party. This puts Cooper in a stronger position as it makes clear he remains popular and trusted by voters.

A compromise bill on expanding Medicaid was introduced by five NC House Republicans in 2017. While it didn’t get a House hearing last year, that may well change in the chamber this year.

The existence of a compromise bill jibes with the Governor’s initial measured statement after the midterm elections. Cooper made clear that expanding access to health care is still at the top of his agenda and indicated he is willing to work with Republicans to get this expansion done.

Legislating is never simple though. The rush to add work requirement rules to Medicaid, an idea floated in the main expansion proposal, may also be reevaluated by both parties in the light of the midterm elections where health care was a top issue for voters.  Just defeated Wisconsin Governor Scott Walker was a outspoken proponent of such Medicaid work rules as well as drug testing. And passage of Medicaid expansion in all three states where it was on the midterm ballot before voters shows strong public support for access to Medicaid coverage in red as well as blue states.

A Republican political consultant in North Carolina recently expressed the sentiment that the GOP could benefit politically from putting their own stamp on extending affordable health coverage through Medicaid: “If I were advising Republicans, I would figure out a way for them to own Medicaid expansion,” he said, adding that some conservatives support that if costs can first be curtailed. “Whoever gets to define the next year in terms of the issues quickly and in a way that doesn’t offend unaffiliated voters can be in the driver’s seat.”

While a roadmap to Medicaid expansion now exists in North Carolina, it is a route with plenty of bumps, detours and steep climbs. Reviews of expansion prospects from knowledgeable state reporters like Sara Ovaska-Few and Richard Craver illustrate the promises and pitfalls around the expansion debate. But a hard look leaves little doubt that the midterm elections have changed North Carolina’s political outlook. North Carolina should be added to Kansas and Wisconsin as a state likely to debate Medicaid expansion this year.

Adam Searing
Adam Searing is an Associate Professor of the Practice at the Center for Children and Families