Old North News

As Gov. Roy Cooper pushes for Medicaid expansion in North Carolina, Republican State Representative and House Majority Leader John Bell is warning against such a move.

The North Carolina General Assembly wrapped up internal negotiations on a two-year state budget recently, leaving it in Cooper’s hands to make the amendments needed for him to sign a final proposal, according to a report by the Associated Press.

"Make no mistake, Medicaid expansion is not free," Bell said in a 2019 tweet. The expansion, which has been pushed by Cooper for years, has continuously been met with resistance by the Republican Legislature. Though Bell has no plans to push for the expansion, a WUNC report states he still hopes to improve access to health care resources for residents.

The next step in finalizing the two-year budget plan is for Republicans to present their reformed plan to Cooper, AP states. Even if Cooper does not approve their modifications, the legislature could still pass their own bill and force Cooper to make a veto decision. In 2019, a stalemate was reached as the governor vetoed the budget and urged for Medicaid expansion to be up for discussion that year, AP states.

A 2017 commentary in the North Carolina Medical Journal, written by Christopher J. Conover, argues that expansion of Medicaid in North Carolina will reduce access to care for the highly vulnerable individuals already on Medicaid. He cites that due to a physician shortage at the time, an expansion "would increase the unmet demand for physician services by over 25%."

Earlier this year, Cooper proposed a major spending increase to get North Carolina back on track from the pandemic, focusing on the expansion of Medicaid in the state, according to a report by AP. The state is currently sitting on unspent funds and $5 billion of federal COVID-19 relief funds, which many believe may be the ticket to bringing healthcare coverage to those who do not have it, WXII 12 reports.

Though Cooper claims the plan would be free to taxpayers in the state, the John Locke Foundation stated in a 2020 analysis of the governor's proposed spending bill that it would leave North Carolina "with a funding gap estimated between $119.3 million and $171.3 million in the first year alone."

Other states that have expanded their Medicare practices in the past have dealt with unanticipated cost increases due to enrollment exceeding projections and the cost per person increasing, according to a 2020 report from the American Legislative Exchange Council (ALEC).

The expansion per-person costs exceeded estimates by 76%, ALEC states, with higher enrollment and costs leading to average cost overruns of 157%. Despite this, writers Brian Blase, Sam Adolphsen and Grace-Marie Turner wrote in a 2020 report for the Galen Institute and the Foundation for Government Accountability that expanding Medicaid has been shown to increase emergency room trips and the waiting time to get seen by a medical provider.

For the state fiscal year 2020, there were 2.1 million Medicaid beneficiaries in North Carolina, 74.7 thousand providers, and 227 million processed claims, the state’s annual report states.

Bell did not respond to requests for comment.