RALEIGH, N.C. (WNCN) – After referencing their years of opposition to the idea, leading Republicans in the state Senate made the case on Wednesday for why North Carolina should expand Medicaid coverage to more than half a million people.

It’s a move Democrats have called on them to take for a decade. The bill would also make a variety of other reforms which the Republicans said are needed to address concerns with access to healthcare.

“If there’s a person in the state of North Carolina that has spoken out against Medicaid expansion more than I have, I’d like to meet that person. In fact, I’d like to talk to that person about why my view has changed,” said Republican Senate leader Phil Berger. “This is the right thing for us to do.” 

Republicans have been at odds with Democratic Gov. Roy Cooper over this issue the entire time he’s been in office, with Medicaid expansion being one of the key reasons Cooper refused to sign any budget into law during his first term. 

North Carolina is one of 12 states that has not expanded Medicaid since the passage of the Affordable Care Act.

“Governor Cooper is encouraged to see progress on getting more people covered with health care in North Carolina and will carefully review this legislation,” said Jordan Monaghan, a spokesperson for Cooper. 

It’s estimated that about 600,000 low-income people would qualify for coverage under Medicaid if the bill passes.  

The federal government pays 90 percent of the cost for states to expand Medicaid. Under the American Rescue Plan, which Democrats in Congress passed last year, they included a provision that temporarily increases the federal share to 95 percent in an effort to entice leaders of non-expansion states like North Carolina to approve Medicaid expansion.

Republicans note that the state would receive about $1.5 billion over two years for expanding Medicaid. 

Sen. Berger had been concerned about whether the federal government would continue to pay its share. Berger says he’s now convinced that won’t be an issue. 

He highlighted three reasons as to why he thinks the state should take this step. 

“We need coverage in North Carolina for the working poor. Second, there is no fiscal risk to the state budget moving forward with this proposal. And, finally, our Medicaid program over the past years has been reformed and transformed,” he said.  

Sen. Joyce Krawiec (R-Forsyth), another long-time critic of Medicaid expansion, called the move a “rescue plan for hospitals.”  

“We are not likely to ever get a better deal than we are being offered now,” she said. 

Many Republicans in the House remain resistant to the idea. House Speaker Tim Moore (R-Cleveland) has not shown support for bringing the measure up for a vote during the current legislative session. 

Demi Dowdy, a spokesperson for Moore, said, “We have been clear with the Governor and our Senate counterparts that Medicaid expansion will only move forward in the House if there are sufficient votes for a bill. Many of our members are concerned about a massive expansion of an entitlement program during record inflation and economic uncertainty. Attaching controversial, unrelated topics to expansion does not help the bill’s prospects for this short session.” 

When asked about the prospect of the House passing the bill, Berger said, “What I’d like to see us do is pass this through the Senate, get it over to the House and continue the process of educating our colleagues.” 

Senate Republicans also are including a work requirement with certain exceptions. 

The Biden administration opposes Medicaid work requirements and has been withdrawing approvals that the Trump administration had granted to states.  

“We will worry about getting the bill passed and then we’ll deal with whether or not that’s something we can convince the Biden administration or convince the courts is the right thing to do,” Berger said. 

Republicans also have included a variety of other changes dealing with access to healthcare in the bill that goes beyond Medicaid expansion. These include provisions to address surprise medical billing and transparency, giving nurses greater ability to practice outside the supervision of a physician (known as the SAVE Act) and certificate of need law reforms and telehealth regulations. 

Chip Baggett, CEO of the North Carolina Medical Society, which represents physicians, said his group supports expanding Medicaid but raised concerns about the SAVE Act provisions being included. 

“The North Carolina Medical Society continues to hold significant reservations about training,” he said. “We think the inclusion of this is a significant harm to this bill and potentially to the state of North Carolina.” 

Jordan Roberts, director of government affairs with the conservative John Locke Foundation, said his group still opposes Medicaid expansion but supports the other aspects of the bill. 

“The state accepting a 10 percent share threatens the budget stability that you all have done such a good job on keeping our budget and spending in check,” he told lawmakers. “If expansion happens, there could be upwards of 3.3 million people on Medicaid. That’s one out of every three people in the state. We don’t think that’s a sustainable program.”