North Carolina has ended years of opposition and opted to expand its Medicaid program in 2024, meaning four in five U.S. states have embraced a key plank of Obamacare as opponents find it harder to resist federal funding and voters force a series of red states to extend coverage.
State Senate Republican Leader Phil Berger’s decision to back expansion marked a turning point and set the stage for legislative approval in Raleigh on the 13th anniversary of the Affordable Care Act’s passage last week.
States are finding it harder to resist the federal dollars that underpin Medicaid expansion, which the Supreme Court made optional for states in 2012 before it was implemented the following year. South Dakota Gov. Kristi Noem opposed Medicaid expansion but the Republican is implementing a voter-approved plan later this year.
Tarheel State legislators were drawn to the benefits for rural hospitals, which will see revenue from newly insured patients. And as COVID-19 recedes, states are combing through their rolls and kicking off persons who are no longer eligible for Medicaid, increasing pressure on lawmakers to figure out who should be covered.
“There are already a lot of fiscal incentives, and then ARPA added an additional fiscal incentive,” Ms. Rudowitz said. An expansion bill in Wyoming advanced out of a committee this year but didn’t get a vote on the state House floor. Kansas Gov. Laura Kelly, a Democrat, has pressed the legislature to take up expansion but the GOP-controlled legislature is resisting.
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