While most of the conversation around the 2016 elections has been on the Democratic and Republican presidential candidates, it’s important to remember that North Carolina will be one of 12 states electing a governor in November. Incumbent Republican Pat McCrory is running for reelection and will most likely face sitting Attorney General, Democrat Roy Cooper. Though the Affordable Care Act is now over six years old, it’s still being used as a political football — and in this race, candidates will play the game. The differences between the candidates for governor will likely focus around Medicaid expansion.
Early in his tenure, McCrory indicated that he may be willing to expand Medicaid eligibility as originally required by the Affordable Care Act (ACA). The landmark case National Federation of Independent Business v. Sebelius, 567 U.S. ___ (2012), 132 S.Ct 2566, made this expansion voluntary, and thus far North Carolina hasn’t chosen to expand the program according to ACA guidelines. Just last fall, McCrory signed a bill into law that would revamp Medicaid in lieu of accepting federal funds to expand eligibility.
The NC legislature and Governor McCrory cite both the need for reform and the decreasing contributions from the feds over time as reasons against expansion. Initially, North Carolina would have received 100% of the additional funds needed to implement the change, but over time that would back down to 90%, leaving an already strapped program on the hook.
Attorney General Roy Cooper has, since last summer, called on McCrory to go through with expanding Medicaid eligibility. Aside from obvious political reasons, Cooper cites a $130 million surplus in the Medicaid budget last year as evidence that the state can afford the change. In fact, Cooper says that the state can’t afford not to do it.
North Carolina’s Medicaid debates aren’t unique. The recently elected Louisiana governor, Democrat John Bel Edwards, signed an order expanding Medicaid eligibility as one of his first moves after taking office. Previous governor Bobby Jindal had refused to do so. As the North Carolina campaign heats up, expect Medicaid expansion to be one of the primary issues between the two candidates — and expect the rest of the country to be watching.