NC governor formally begins Medicaid expansion pursuit

RALEIGH, N.C. (AP) — North Carolina's new Democratic governor on Friday formally started his effort to expand Medicaid to more of the poor and middle class lacking insurance, even as Republicans in Washington bear down on repealing the federal health care law that offers this coverage option.

Cooper's office said he sent a letter to federal regulators altering them of his intentions to seek changes that could provide health care to more than 500,000 people starting in January 2018. He had announced earlier this week his pursuit of Medicaid expansion, which runs against the rising tide on Capitol Hill to get rid of President Barack Obama's health care overhaul.

Leaders of the GOP-controlled state legislature have opposed expansion and on Thursday asked the Centers for Medicare & Medicaid Services to reject Cooper's request, filed days before Obama leaves office.

Friday's action sharpens further political rancor between Cooper and the GOP legislature, which last month passed two other laws before Cooper took office that weaken his gubernatorial powers. Cooper already has sued over one law. A three-judge panel has blocked enforcement of the law involving elections oversight. Cooper, the attorney general for the last 16 years, narrowly defeated Republican Gov. Pat McCrory in November.

Cooper is acting even though a 2013 state law prevents him from seeking expanded coverage without the legislature's formal support. Those legislators say his request is therefore illegal, but Cooper's office said in a Friday news release that law "doesn't apply to his draft plan." The release doesn't explain why.

With support from President-elect Donald Trump, Republicans in control of Congress are promising to repeal Obama's signature law, which includes the ability of states to cover more uninsured working people. Cooper said this week he believes that the expansion option will be one program that remains in place and that North Carolina should benefit.

Cooper said getting a portion of federal funds now going to more than 30 states that have expanded Medicaid could generate jobs, help struggling rural hospitals and reduce expensive emergency care for people who can't afford insurance.

"This is North Carolina common sense," Cooper said. "We can receive between $3 billion and $4 billion to pay for care that hospitals and other providers now give away."

States currently only have to cover 5 percent of the costs, but that share reaches 10 percent in 2020. Studies estimate North Carolina's share ultimately could cost as much as $600 million annually. Cooper said the state could pay for the expansion from assessments on hospitals — up to $150 million in the first year — and savings in existing state expenditures.

Republican lawmakers say Cooper's proposal would lead to tax increases.

"Even if the governor had the authority to submit the amendment, such a decision should not be made unilaterally without the consultation of the legislature," North Carolina House Speaker Tim Moore and Senate leader Phil Berger wrote Thursday to the Centers for Medicare & Medicaid Services' top administrator.

Cooper told reporters this week he hoped Republican legislators would work with him on expansion. Other state laws leave it to the General Assembly to shift eligibility standards for Medicaid, which currently covers 1.9 million people in North Carolina. Cooper's release acknowledges eligibility requirements must be changed for expansion to go forward.

Cooper's office said the state will accept comments for 10 days on its notice to amend its Medicaid program, after which the detailed plan amendment will be filed with federal regulators.