N.C. set to expand Medicaid, leaving 10 states holding out against Obamacare plank

Democratic Gov. Roy Cooper says he is eager to sign a bill that makes North Carolina the 40th state to expand Medicaid coverage under Obamacare.

The GOP-controlled state legislature reversed years of opposition to expansion and voted to approve the plan on Thursday, the 13th anniversary of the passage of the Affordable Care Act.

"Medicaid Expansion is a once in a generation investment that will make all North Carolina families healthier while strengthening our economy, and I look forward to signing this legislation soon," Mr. Cooper said on Twitter.

Obamacare allows states to expand eligibility for Medicaid coverage to those making up to 138% of the federal poverty level.

Roughly 600,000 North Carolina residents are expected to become eligible for the federal-state insurance program started in 2024, when the state will begin to draw down federal matching funds that pay for at least 90% of the costs of the expansion population.

North Carolina lawmakers were enticed by the benefits for rural hospitals and extra matching funds from the federal government in President Biden's 2021 virus-relief law.

It is clear that Obamacare won't be repealed soon, and the end of the COVID-19 emergency will prompt states to comb through their rolls and kick off persons who are no longer eligible for Medicaid under pandemic protections, increasing pressure to sort out the expansion question.

North Carolina's decision to embrace a key plank of Obamacare is unusual because the legislature decided to implement it. In other states, voters are forcing the issue through ballot measures.

For instance, South Dakota Gov. Kristi Noem opposed Medicaid expansion, but the Republican is implementing a voter-approved plan later this year.

Once Mr. Cooper signs the North Carolina bill, there will be 10 states left that have not expanded Medicaid under Obamacare: Alabama, Georgia, Mississippi, Florida, Kansas, South Carolina, Texas, Tennessee, Wisconsin and Wyoming.

Wisconsin extended coverage to persons making the federal poverty level but hasn't embraced the full Obamacare expansion.

States that have refused to expand Medicaid typically point to state costs from expanding the rolls. They say even the 10% share for states will bloat the government program and ruin their budgets.

The Obama and Biden administrations have pressed Florida and Texas, in particular, to expand, saying those massive states could slash the national uninsured rate.