NC Republicans announce Medicaid expansion
The vote is not planned until later this month. Until then anything can happen. On Thursday, however, Tar Heel State Republicans in firm control of the state legislature announced a deal for Medicaid expansion under the Affordable Care Act. North Carolina would be the 40th state to expand Medicaid after a decade of Republican resistance.
The Washington Post reports:
The deal marks a stark turnaround for Republican leaders that played out over years in North Carolina and in states across the country, as more and more governors and legislatures expanded Medicaid to low-income residents. When that stopped working years ago, advocates put the measures on the ballot in seven conservative-leaning states, and voters approved expansion in every one.
“This is something that we can all be very proud of,” House Speaker Tim Moore said at a Legislative Building news conference with Senate leader Phil Berger. “What a huge announcement this is for North Carolina. What a huge policy direction this is that will provide help for so many in this state, but it’s going to do it in a way that’s fiscally responsible.”
Gov. Roy Cooper, a Democrat, will of course sign the bill if it makes it to his desk.
Passage would extend Medicaid coverage to 600,000 of the state’s poor citizens. That’s huge. Stopping the closing of even more rural hospitals is a relief (although little consolation to the dead). “Since 2005, 11 North Carolina rural hospitals have closed or been converted to some other type of facility,” North Carolina Health News reported in August 2022 .
Call me cynical, but my first question is: Why now?
North Carolina has no ballot measure process. Perhaps Republicans are simply “capitulating to … fundamental financial logic” on Medicaid expansion, as Paul Waldman and Greg Sargent suggest in the Washington Post. Meanwhile, Republicans on Capitol Hill are are still looking at cutting Medicaid or turning it into a system of block grants and at reducing funding.
That tension will prove thorny for the party’s 2024 presidential nominee:
The eventual GOP nominee will surely want to keep the debate over the ACA as abstract as possible. He or she will likely rail that “Obamacare” represents Big Bad Government in some undefined sense while vaguely committing to repeal to keep the base and conservative thought leaders happy.
But the Medicaid expansion in places such as North Carolina will make the stakes a lot more concrete. The repeal vow will threaten the coverage of hundreds of thousands in that state. The expansion would deliver a big lift to struggling rural hospitals there, as it has in other expansion states. These gains will also be threatened.
All of that won’t be easy for the GOP nominee to navigate in a state that Republicans have been winning lately, but only by very slim margins.
But it’s not likely the 2024 presidential race on the minds of Moore and Berger, but the governor’s mansion. Roy Cooper is the only person standing between them and complete and utter GOP control in North Carolina for decades to come, and Cooper is term limited.
North Carolina Attorney General Josh Stein has announced a run for governor and is the presumptive Democratic nominee. The leading Republican candidate for governor in 2024 is Lt. Governor Mark Robinson. If you need reminding who Robinson is (from November 2021):
When clips of a speech by North Carolina Republican lieutenant governor went viral this week, many will not have recognized the dominionism behind his promise that “Christian patriots will own and rule this nation.” But when he declared non-Republicans “our enemies” and the most populous state in the U.S. “Commie-fornia” [timestamp 8:10], what he put on public display was Christofascism.
All that will be fodder for outside campaign ads against Robinson in 2024.
“Since becoming attorney general in 2016, Stein has secured landmark legal victories against drug makers and tobacco companies,” WRAL reports. Stein is one of the few North Carolina Democrats to win statewide office in recent years:
Robinson could also be vulnerable, Democrats say, because of his affiliation with former President Donald Trump, whose support is seen by some to have hindered far-right gubernatorial candidates in other states last year. Arizona’s Kari Lake and Pennsylvania’s Doug Mastriano lost their races despite support from Trump, who praised Robinson last year as the two shared a stage in Wilmington.
But some political analysts see a Stein-Robinson contest as being tighter than those other swing states.
“Robinson has some potential to be a toxic general election candidate,” J. Miles Coleman, associate editor of Sabato’s Crystal Ball at the University of Virginia’s Center for Politics, said in an email. “But NC is a fundamentally tougher state for Democrats” than Pennsylvania or Arizona, he said.
Unlike Lake and Mastriano, Robinson has won a statewide race — receiving more votes for lieutenant governor in 2020 than Stein did for attorney general. Last year’s midterm elections also showed positive signs for Republicans as they won a big U.S. Senate race and improved their performance in some of the Democrats’ long-held rural counties.
North Carolina Democrats’ new state chair, Anderson Clayton, 25, has declared her intention to contest those rural counties aggressively in 2024.
Republicans have reason to bolster Robinson. The N.C. governor’s race is the only toss-up on Sabato’s map as of this morning. Moore and Berger will want to give their eventual candidate every edge they can. Republicans need something like Medicaid expansion to, you know, show 2024 voters they care.
About more than absolute power.
UPDATE: Why you should care about North Carolina’s governor’s race. How the Fall of Roe Turned North Carolina Into an Abortion Destination