The intensifying debate on how to expand Medicaid coverage in North Carolina has Democratic Gov. Roy Cooper expressing his support for a two-track negotiating process for the 2019-20 state budget.

Cooper’s office said in a memo posted Thursday that he hosted Republican House and Senate budget writers and Democratic leaders at the mansion Wednesday.

Cooper offered his proposal of one negotiating track focused on health care issues, including Medicaid expansion, with state health Secretary Dr. Mandy Cohen in charge.

The other track would be “on the larger budget framework.”

Cooper’s attempt to insert Medicaid expansion into the state budget process is expected to lengthen — by weeks or months — approving the budget and ending the 2019 session. The typical goal is concluding the session around the Fourth of July holiday period.

Medicaid expansion would affect 450,000 to 650,000 North Carolinians, experts have said. The House or Senate budget plans do not contain Medicaid expansion.

The memo said legislative Republicans left the meeting without agreeing to that proposal, “and the ball remains in their court on this issue.”

“With just 11 days left in the fiscal year (which ends July 1), legislative Republicans are simply refusing to come to the negotiating table.”

Bill D’Elia, spokesman for Senate leader Phil Berger, R-Rockingham, said Thursday that he found the memo confusing since “(House) Speaker Tim Moore and Sen. Berger called the governor well before that memo went out asking him to meet (Thursday) to negotiate the budget.”

The governor’s office released a similar memo Wednesday in which Cooper “expressed his desire for a budget that he can sign, and that it would be better to have serious budget negotiations now instead of a drawn-out process.”

Thursday’s memo claimed Republicans have “so far tried to negotiate through a series of letters. ... None of this shows the least sincerity in attempting to find common ground” on a potential House and Senate budget compromise.

“Republicans have very clearly worked out their conference budget among themselves,” according to the memo. “They haven’t accepted Gov. Cooper’s offer at a real negotiation because their budget is done and they’d rather engage in a charade for political gain.”

“Gov. Cooper made clear at Wednesday’s meeting that he wants everything on the table — including Medicaid expansion ... and that corporate tax cuts, school vouchers ... took important budget availability away from priorities, like education and health care.”

Budgets can be used to leverage priorities, said Rep. Donny Lambeth, R-Forsyth, and a key House budget writer.

“In the case of the governor, he has his set of priorities,” Lambeth said. “In many areas, they match up well with the General Assembly.

“But certainly, there are areas that do not and he has a limited number of options to have his priorities debated.”

Expansion

An administration official indicated Tuesday that it is too early to say whether Cooper would veto a compromise budget plan, even though Sen. Harry Brown, R-Onslow, claims Cooper’s office won’t conduct budget negotiations without expansion.

Since the GOP super-majorities in both chambers ended with the 2018 general election, Cooper can veto any public bill if he has the unanimous support of the 21 Democratic senators and loses no more than six Democratic votes in the House.

Brown said in a statement Tuesday that “it’s not in the best interest of the people of North Carolina for the governor to stop a $24 billion budget because of one policy item.”

The reality of spinning Medicaid expansion out of state budget negotiations is that GOP legislative leaders, led by Berger, have chosen not to address two Democratic-sponsored bills that would expand Medicaid, nor the Republican option introduced by Lambeth that has bipartisan support.

House Bill 655 contains two controversial elements: a work requirement for some Medicaid recipients between ages 19 and 64; and an assessment for health care systems and prepaid health plans (PHP) to pay for the state’s 10% share of additional administrative costs. Health-care systems and PHPs operating in the state would pay $758 million annually.

The federal government would pick up the remaining 90%, although Berger and other key GOP Senate leaders have tried to cast doubt on the sustainability of those federal funds.

Berger released a statement March 11 in which he called the health-care assessment a tax that he claimed would be passed on to patients.

Cooper’s budget plan recommends expanding Medicaid “to bring $4 billion into North Carolina’s economy, create an estimated 40,000 jobs and provide more affordable health care for 500,000 people,” according to his office.

Expansion would allow many of those residents to be covered by health insurance, giving them access to affordable primary physician care and reduce the dependency on hospital emergency-department services.

The program already serves 2.14 million North Carolinians, representing about 21% of the state population. Another 1.6 million will be enrolled in Medicaid through a new managed-care program that is being rolled out in the state.

Sen. Paul Lowe, D-Forsyth, said he would hope that budget talks could yield a compromise with the governor before the need for a veto.

However, he said “the governor will be able to sustain his veto of the state budget with the 21 Democrats, and we know Senator (Phil Berger) has been awful tough on this issue.”

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