PoliticsHealth Care


In rare bipartisan move, North Carolina Medicaid expansion begins

Advocates say the change could serve as a road map for other states that have failed to expand the program.
Posted at 3:21 PM, Dec 01, 2023

Brenna Dawson walks each day with a certain weight hanging over her head.

The North Carolina resident is among the 2.1 million uninsured adults in America stuck in a so-called health care coverage gap. It's been months since Dawson had health insurance, and with looming health problems she's avoided routine visit to the doctor.

"I've been neglecting the things that should be taken care of, and they're just not being taken care of," Dawson said on a recent fall afternoon.

As a stagehand at a local theater, Dawson only makes around $15,000 a year. She currently doesn't make enough money to be able to afford health care coverage under the Affordable Care Act. But up until recently, she was eligible for Medicaid.

"What if I get hurt? What if I have to go to the hospital? I'm not going to be able to cover anything," Dawson said about not having health insurance. 

This North Carolina resident's journey, though, recently took a turn after the state she lives in voted to expand Medicaid earlier this year. In a rare bipartisan move back in April, North Carolina lawmakers expanded the state's Medicaid program, giving health care access to an estimated 600,000 residents. Advocates say the change could serve as a road map for other states that have failed to expand the program. 

In an interview with Scripps News, Democratic Gov. Roy Cooper said he believes it's a move that will save lives.

"We have over a million people in North Carolina who are uninsured, and this will help make a big dent in that," Cooper said in the interview. "It's going to save lives. Bottom line."

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Earlier this year Gov. Cooper found common ground with a Republican-controlled state legislature to make the unthinkable happen: the passage of Medicaid expansion.

Ten states have yet to adopt Medicaid expansion: Wyoming, Kansas, Texas, Wisconsin, Tennessee, Mississippi, Alabama, Georgia, South Carolina and Florida. All of those states have Republican-controlled state legislatures that have pushed back against Medicaid expansion. But in North Carolina an unusual coalition of businesses, local law enforcement and state lawmakers found common ground on the issue. Part of the plan will also expand mental health care access across the state. 

"We have a road map for [other states] if they're willing to take it," Gov. Cooper said.

On Dec. 1, more than 600,000 North Carolina residents will have new access to health care.

"If we can come together and get this done other states can too," said Kody Kinsley, who serves as the state's secretary of Health and Human Services. 

Kinsley believes what ultimately got the legislation over the finish line was money: Because of a provision in the American Rescue Plan, North Carolina will get an additional $1.8 billion from Washington for expanding Medicaid. Kinsley says that's a big reason why lawmakers who once opposed expansion are now convinced that the working poor will benefit.

"Investing in health and health insurance isn't just about what happens at the doctor's office," Kinsley added.

Rebecca Cerese, who oversees the North Carolina Justice Center, sees the expansion of Medicaid as a move that will help residents get more preventive care.

"This is a huge day for us," Cerese said.

Cerese's biggest concern now is that many residents of North Carolina who have never had health care before may not know they're now eligible for coverage.

"It's going to be difficult. We fought long and hard. We want to make sure every last person who is eligible for enrollment gets enrolled," she said.