The details of a deal reached by North Carolina legislative Republicans to expand Medicaid to hundreds of thousands of low-income adults received overwhelming initial approval from the state Senate on Tuesday.
The 43-2 vote on formal legislation comes less than two weeks after House and Senate leaders unveiled an agreement that could cover 600,000 people who make too much to qualify for conventional Medicaid but not enough to obtain highly subsidized private insurance.
North Carolina, currently with 2.9 million enrollees in traditional Medicaid coverage, is one of 11 states that haven’t yet adopted expansion.
“We have been talking about this for a long time,” said Sen. Joyce Krawiec, a Forsyth County Republican. She shepherded the bill on the Senate floor Tuesday after opposing the expansion idea for many years.
Republicans in charge of the legislature were skeptical over the past decade about expansion, made available through the 2010 Affordable Care Act. But the tide changed over the past year as lawmakers became more comfortable with the idea. They also were tempted with the receipt of an additional $1.8 billion over two years from Congress if North Carolina signed on now. Many state officials want to earmark a great deal of that money for mental health services statewide.
An agreement reached after weeks of negotiations earlier this month also included provisions that eased or eliminated certain “certificate of need” laws that require health regulators to sign off on plans for medical entities to build locations or purchase equipment. The Senate demanded such changes as a way to increase the supply of services for the larger covered population.
The measure must pass the Senate a second time, probably on Wednesday, before it goes to the House for likely final action by the General Assembly. Democratic Gov. Roy Cooper, a longtime expansion advocate, would be asked to sign the bill into law.