Medicaid expansion left undone as lawmakers adjourns

Medicaid expansion left undone as lawmakers adjourns


By Anne Blythe

North Carolina lawmakers were back in Raleigh on Tuesday for Senate and House sessions in which Republican leaders of each chamber used different strategies for conducting the day’s business.

Phil Berger, the Republican from Eden who leads the state Senate, used a quick gavel for a so-called “skeletal session,” with the bare minimum of members or procedure: Open for a prayer, the pledge of allegiance, then adjourn again until 11 a.m. Friday.

No time even for Sen. Wiley Nickel, a Democrat from Wake County, to make a valedictory speech from the Senate floor. He asked to take a “point of personal privilege” to list accomplishments during his three two-year terms, as well as list his hopes for those following him as he moves to the U.S. congressional seat he won in November. But Berger cut him off when he made the request, telling him that during skeletal sessions, there were no opportunities for personal privilege.

Instead, Nickel, who begins his congressional term next month, met with reporters before the Senate session with his wife Caroline, daughter Adeline and son Prescott at the press room podium with him. There, one of the achievements he listed was the Senate’s vote earlier this year to expand Medicaid, a thorny topic for Republicans that Democrats have advocated for many years.

In June, Berger told his chamber that expanding Medicaid “is the right thing to do, and it’s not even close.”

But it was not to be.

Medicaid expansion stalemated

Tim Moore (R-Kings Mountain), Speaker of the North Carolina House of Representatives talks with Greensboro Democrat Pricey Harrison after the chamber’s session Tuesday, Dec. 13, 2022. Credit: Anne Blythe

The expansion, something made possible by the 2009 Affordable Care Act, would allow some half million or more low wage workers onto the program to gain access to health care. Usually, Medicaid is limited to low income children, some of their parents, people with disabilities and low income seniors.

Moore asserted throughout the summer that the House might come back in late November or December to take a vote on Medicaid expansion, once the election was over.

In June, Moore put forward a proposal to create a legislative committee with members from both chambers that would hear a Medicaid Modernization Plan to be developed by the state Department of Health and Human Services. This committee would come on the heels of a different study committee that met six times from February to April. 

The House never took a vote on the bill adopted by the Senate and championed by Berger. Embedded in the Senate’s proposal was a measure to weaken North Carolina’s certificate of needs system, a suite of laws and regulations intended to cut down on health care competition. Also part of the Senate’s proposal was a provision to give advanced practice nurses more latitude in their practice.

Speaker Tim Moore, the Republican from Kings Mountain who leads the House, said his chamber does not support the proposed certificate of need changes, which face opposition from the powerful lobby of the North Carolina Healthcare Association. Meanwhile, the North Carolina Medical Society opposed changes to how nurses practice.

Berger was unwilling to move forward with expansion without changes to the other proposals. So the two chambers remained in a stalemate that lasted for the rest of the year, leaving expansion tantalizingly out of reach for advocates.

This means the expansion of Medicaid in North Carolina will be delayed until at least 2023 as all those low income workers, family caregivers, students and others who could qualify for the publicly-funded health care continue waiting on the next step.

What’s ahead in 2023?

Moore, who gave members of the House the opportunity to give good-bye speeches and words of appreciation to colleagues and legislative staff they had worked with, met with reporters afterward to talk about what’s next for his chamber.

After the 2023 legislative session opens in January and lawmakers begin to get down to serious business sometime in February, Moore said he expected there to be talk among Republicans about new laws restricting abortion in North Carolina, a testing of the appetite for medical marijuana access and, once again, the perennial issue — Medicaid expansion.

The House will get 30 new members in January, and Moore said Tuesday he doesn’t have a great sense of where they all stand politically.

If the lawmakers in his chamber vote a straight party line, there are not enough votes to overturn any laws that Gov. Roy Cooper, a Democrat who has sometimes been a thorn in their side on politically divisive issues.

Cooper has said he intended to veto any bills that would restrict abortion access.

Moore told reporters he thought he might be able to bring some Democrats along with him on some issues, but declined to reveal who those members might be and precisely which social issues he thought they might join in with the majority.

“We have, essentially what I would call a governing supermajority,” Moore said.

He hopes.

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