Bipartisan Medicaid Expansion Efforts in North Carolina: How Politicians Formerly Opposed to Expansion Are Framing Their New Support

In a reversal of the longtime opposition of many members of their caucus, House and Senate Republicans in North Carolina have joined Democratic colleagues and shown overwhelming support for Medicaid expansion in North Carolina’s 2022 legislative session. Both chambers have passed their own Medicaid expansion bills with nearly unanimous support from both parties, although they have yet to come to agreement with Democratic Governor Roy Cooper on how to move forward.

While both policy and political reasons played into this new bipartisan consensus around expanding coverage – and although a bill has yet to be enacted into law – one interesting aspect of the political change in the state has been how former opponents of extending Medicaid coverage have been describing the factors that led to the change in their positions.

To gain some insight we took a close look at the media coverage of this issue in the state over the last six months. We wanted to know what kinds of arguments in favor of Medicaid expansion were most salient to members of the legislature and focused on House and Senate Republicans who had changed their positions. We looked at multiple print articles appearing in three large sources of coverage in the state. We also found coverage in other news sources, but didn’t find it significantly different than what we found in WRAL, the News and Observer and the AP.  Overall, we found the messages used heavily focused on substantive issues like who would be helped, the economic effects, and the respective roles and responsibilities of the state and federal governments.

Here are the five main themes we found former opponents used in describing the change in their positions on Medicaid expansion:

  1. Medicaid expansion will help North Carolina’s working poor parents

“[GOP Senate leader Phil Berger] pointed to an example given by fellow Republican Sen. Kevin Corbin, who works in health insurance and spoke about a single mom with two kids, making around $25,000 a year, who’d be considered too wealthy to qualify for Medicaid now, unless expansion is approved. ‘That’s one thing my perspective has changed on,’ Berger said, adding: ‘Life just beats her down. And if there’s something we can do to keep that from happening, we ought to take that opportunity.’” (The News & Observer)

  1. Medicaid expansion is good state fiscal policy that will bring money back to North Carolina already being paid by NC taxpayers

“North Carolina taxpayers already send dollars to Washington to pay for expansion, and it’s time to bring that money home, he [GOP House Speaker Tim Moore] said. North Carolinians already absorb health costs for uninsured people in the state, who often seek care in hospital emergency rooms, in the form of higher insurance premiums and other hidden costs, he said” (WRAL)

A variation on this argument is that federal incentives to expand are attractive enough now to make the change:

“‘This is an opportunity to take federal dollars, actually present a savings to the state of North Carolina and increase access to health care.’ House Speaker Tim Moore told colleagues in June. ‘I’d call that a pretty good trifecta to do those things.’” (AP) [See this article for a more detailed discussion of the substantial federal incentives available for Medicaid expansion.]

  1. It is clear that the Affordable Care Act is here to stay, and the federal government can now be trusted to hold up its end of the bargain on expansion 

“After years of Republicans trying to kill the program, along with the 2010 Affordable Care Act it was part of, expansion and the federal promise to find 90% of its costs are clearly here to stay, [GOP House Speaker] Moore said. ‘It stayed in place with a Republican [U.S.] House, a Republican Senate and a Republican president,’ Moore said. ‘If it didn’t change under that, when’s it going to change? So the feds have made their decision on that.’” (WRAL)

  1. Medicaid expansion will happen “sooner or later” regardless of what the NC General Assembly does, so North Carolina should take the opportunity to create a plan for expansion

“And in an argument aimed at conservative skeptics, Moore said he believes Medicaid expansion will probably happen here sooner or later no matter what the legislature does now. He urged them to see this as an opportunity for Republicans to craft the rules they want. ‘Instead of the feds or anyone else just creating something and sending it here, this is something we have the opportunity, from start to finish, to make sure it makes sense for North Carolinians,’ he said.” (The News & Observer)

  1. Medicaid expansion would help rural hospitals and rural economies

“Around a dozen hospitals in rural parts of the state have shut their doors in recent years — including one in Franklin County, northeast of Raleigh, an area that Nashville Republican Sen. Lisa Barnes used to represent.

‘I know what it’s like for a community to lose its hospital,’ she said. ‘…In fact, North Carolina ranks third in the nation for hospital closures. That’s something I am not proud of. Imagine the devastating economic effect that hospital closures have in rural areas. It’s hard enough for these areas to retain businesses and residents, much less try to attract new businesses and people.’”  (The News & Observer)