NC governor pledges to expand Medicaid, despite state law

RALEIGH, N.C. -- Setting up more conflict with the Republican-led legislature, new North Carolina Democratic Gov. Roy Cooper on Wednesday announced plans to expand Medicaid through the federal health-care overhaul, though a state law specially prevents such unilateral action.

Cooper, the state's attorney general for the past 16 years before narrowly beating GOP Gov. Pat McCrory in November, announced at a New-Year economic forum he plans to file paperwork with federal regulators by Friday.

Cooper's action comes in the waning days of the administration of President Barack Obama, who championed the 2010 health-care law and wants to protect his legacy, and as President-elect Donald Trump and Republican congressional leaders pledge to repeal it.

As many as 650,000 working people who can't get private insurance or otherwise make too much to get Medicaid could benefit, generating jobs, helping rural hospitals and boosting the economy, Cooper said.

Under the proposal, the state would have to match 5 percent of the cost, which the governor said could come from an assessment on hospitals that stand to benefit.

"We have to accept Medicaid expansion that is being offered to our state," Cooper told business leaders in Durham.

The governor, sworn in last weekend, will be hard-pressed to bypass a 2013 state law approved by McCrory and GOP legislators that declares North Carolina won't expand Medicaid and states the General Assembly must sign off on any proposal by state officials to do so.

Other laws leave it to the General Assembly alone to determine who is eligible for the state Medicaid program, which covers 1.9 million people.

GOP legislative leaders said Cooper would violate state law if he went forward.

The lawmakers planned to ask Congress and federal Medicaid regulators to reject Cooper's request.

Cooper "already intends to violate his oath of office with a brazenly illegal attempt to force a massive, budget-busting Obamacare expansion on North Carolina taxpayers," Senate leader Phil Berger, R-Rockingham, said in a news release.

But Cooper said after his speech that the 2013 law intrudes upon a governor's "core executive authority" to accept federal funds and look out for the public's health.

"I would hope that they would not try to stop us, but I believe it would be important to get their input, so I'm looking forward to that input as we go forward," he told reporters.

Berger's House counterparts also jumped on Cooper's comments that the state's share, potentially in the tens of millions of dollars initially, could come from taxpayers or the hospitals -- proof that he wants to raise taxes, they said. The state match rises to 10 percent in 2020.

Health-related associations praised Cooper's move, but with caution. "Given the complexity of the issue and the process, we believe coverage expansion can only happen through a bipartisan, collaborative effort," the North Carolina Hospital Association said in a release.

Cooper already has sued Berger and House Speaker Tim Moore over a law the General Assembly approved two weeks before he took office that would weaken his authority to oversee state elections. That law has been temporarily delayed. A hearing to block its enforcement longer is slated for Thursday.

North Carolina is one of 19 states that haven't expanded Medicaid through Obama's signature legislation. Republicans in Raleigh said in 2013 it was the wrong time to expand Medicaid because of the state program's fiscal shortfalls and they couldn't trust the federal government to continue paying for most of it.

North Carolina Medicaid has been in the black for the past three years. In 2015, state lawmakers and McCrory agreed to rework the system, replacing a fee-for-service structure with one in which insurers receive a fixed monthly amount to care for patients.

Cooper may want to get expansion approved before Obama leaves office, given Medicaid expansion's uncertain future under a Trump administration -- and before the state negotiates details of the ongoing reform with the federal government, said Don Taylor, a Duke University professor specializing in health care policy.

"We found very receptive people in Washington who are working with us and who are ready to do this" expansion, Cooper said, without identifying them.