Alexander Jones: Medicaid expansion would be a signal achievement

Published 12:00 am Wednesday, June 8, 2022

Republicans such as Senator Phil Berger opposed Medicaid expansion so tenaciously it almost seemed to be a matter of religious conviction. As Berger himself liked to argue, most of the uninsured in North Carolina were “able-bodied men,” whom he deemed unworthy of public support. This was very consistent coming from a man so fervently committed to punishing the undeserving. In the real world, most people making too little for private-insurance subsidies, but too much for Medicaid, were in the workforce already. But reality is rarely an obstacle for Republican austerity hawks.

That is, until now — maybe. In the weeks since legislators convened for their short session, Republicans in the state Senate, led by Berger himself, have notably softened on the issue of expanding Medicaid. It’s hard to overstate the improbability of this development: Medicaid expansion has been the center of political combat in North Carolina since even before Roy Cooper took office as governor. Disagreements over expansion cost the state a budget in the 2019-2020 biennium, and conservative “think tankers” hailed Cooper’s willingness to sign a budget without it as a signal victory for conservatism.

Yet here we are, with Governor Cooper’s longtime policy goal firmly in sight. House Republicans have toyed with Medicaid expansion for several years, even though they nixed the initiative last year due to Speaker Tim Moore’s insecurities about his place in a GOP Congressional primary. (Thanks again, Madison Cawthorn.) It’s the flipping of Berger – pun acknowledged, but not intended – that’s most remarkable and significant. For ten years, Phil Berger has roamed the halls of the legislative building as North Carolina’s ruling autocrat. He almost always gets exactly what he wants. And now that list of desires apparently includes Medicaid expansion.

I’m not here to spike the football — not least because Medicaid expansion is still far from a reality. Berger’s embrace of the fiscal argument for Medicaid expansion is as rich as Belgian chocolate. The Republicans, so long committed to rewriting the social contract and repealing a century’s worth of social policy, have now come to the realization that denying people healthcare is not a reasonable price to pay for the sake of poking a stick in the eye of the American progressive movement. It seems they have finally gotten tired of cutting off North Carolina’s nose to spite its face.

Credit for the potential expansion of Medicaid goes, above all, to Governor Roy Cooper. A governor without Cooper’s iron integrity and indefatigable will might have given up on Medicaid expansion years ago. Cooper, on the other hand, has kept driving for expansion year after year no matter how frustrating his quest must at times have become. The governor already has a signature achievement in his leadership, nearly unparalleled in the nation, during COVID-19. Medicaid expansion will be another impressive victory that may just attract the attention of Democrats looking for the next American president.

Alexander H. Jones is a policy analyst with Carolina Forward. He lives in Chapel Hill. Have feedback? Reach him at