The issuance of ultimatums — whether real or perceived — has approval of a new state budget stuck over Medicaid expansion in North Carolina.

Attempts to reach across the aisle in Raleigh for votes (Republican legislators to support expansion, Democrats to support an expansionless budget) are being decried as interloping, if not bribery, with GOP offers of earmarking money in the budget for special projects in Eastern North Carolina to sway those Democratic legislators.

All of which makes it more likely that budget negotiations will take weeks, if not months, to reach a compromise.

The latest salvo was fired Thursday by the N.C. Senate’s 29 Republicans in a letter they sent to Democratic Gov. Roy Cooper stating their opposition to Cooper’s budget proposal.

Cooper vetoed the GOP budget compromise June 28. It would take every GOP legislator, as well as at least seven Democratic votes in the N.C. House and at least one Democratic vote in the Senate to override the veto.

The letter was sent as the House Republican leadership chose to take a four-day break — until Monday night — from considering voting on the veto override and Medicaid-expansion legislation, House Bill 655. The House took up neither in its seven most recent floor sessions.

Cooper expressed, including in an interview with the Winston-Salem Journal last week, his confidence in not only the budget veto surviving an override vote but also of enough GOP votes to pass HB655.

“We definitely have the votes in the House for passage of the Medicaid expansion bill even with the work and premium requirements, but that alone doesn’t get Medicaid expansion,” Cooper told the Journal.

The House Health Committee recommended HB655 by a 25-6 vote July 8. The bill was fast-tracked to the House floor July 9, where it has sat unaddressed since.

Cooper said that “there are nine to 10 Senate Republicans who are amendable to a settlement on Medicaid expansion.”

The Senate GOP’s letter claimed that Cooper’s supposed speaking “on behalf of Senate Republicans ... mischaracterized our body’s budget position.”

The letter was designed to “outline the Senate Republican caucus’ budget position to you. ... With respect, we do not presume to speak for you or your positions. We request the same courtesy in return.”

The GOP senators stressed their belief that the latest version of the budget “reflects compromise between the House, Senate and Executive Branch.”

“We passed a good solid budget with bipartisan support,” said state Sen. Joyce Krawiec, R-Forsyth. “The governor has refused to allow the budget to become law unless he gets what he wants.

“Teacher raises, school funding, state employee raises and many more important spending priorities are put on hold because of the governor’s refusal to work with the legislature,” Joyce said. “I hope he reconsiders.”

Special session offered

The Republican senators repeated their offer of holding a special session after the budget is signed into law “devoted exclusively to health care access issues, including your top priority of Medicaid expansion.”

“We oppose your ultimatum that no 2019-21 budget will become law unless the legislature first passes Medicaid expansion,” the letter said.

Cooper said last week that it is “a fantasy to think Medicaid expansion would happen in a special session.” Analysts have said that once Cooper signs into law a state budget without Medicaid expansion, he will lose his leverage on the issue.

Cooper has said he supports a two-track approach to ending the current session, with one focused on health-care issues, including Medicaid expansion, with the N.C. secretary of health. Dr. Mandy Cohen, in charge. The other track would be “on the larger budget framework.”

According to a statement from Cooper’s office, his 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.”

“It needs to be in the budget because it would add $4 billion to the $24 billion budget, and it would prove to be one of the most pivotal economic initiatives the state has ever undertaken,” Cooper said. “There’s no reason to hold a special session on health care when there is a vehicle to move forward in front of us now.”

Given the intense opposition from Senate leader Phil Berger, R-Rockingham, and other key GOP senators, there is no guarantee HB655 or any expansion legislation would be heard in the Senate during the current session or a special session.

Some analysts say that reality makes Berger’s pledge hollow.

Berger has criticized HB655 for including an assessment charge to hospital and medical providers that he says will serve eventually as a tax on patients. The bill has drawn criticism for requiring Medicaid recipient work and pay a premium to help finance health insurance.

Mitch Kokai, senior policy analyst with the John Locke Foundation, a conservative-leaning research group, said Senate Republicans likely would use a special session “to promote ideas that would work better to boost health-care access and reduce costs; certificate-of-need reform; reduced restrictions on health practitioners’ scope of practice; and other market-oriented ideas that focus on the supply side of health care.”

However, those Senate legislative efforts have drawn resistance in the House.

“The letter signifies that Gov. Cooper is not likely to see much success trying to drive a wedge between Republican Senate leaders and the rest of the GOP caucus,” Kokai said. “Sen. Berger is not the only Republican who considers Medicaid expansion to be a misguided proposal.

“As long as the governor refuses to budge from his insistence on a budget deal including Medicaid expansion, a deal is unlikely.”

Back-and-forth debate

Cooper responded to the Senate GOP’s letter by issuing a statement on the governor’s office website that asks where is the Senate GOP’s counterproposal is to his budget compromise released July 8.

“The offer would close the health care coverage gap, raise teacher pay, cut taxes for people and guarantee school construction while balancing the budget and saving money in the rainy day fund,” the statement said. “It also included all the local projects that were in the Republican legislative budget.”

“The ball is in the Republicans’ court,” Cooper spokeswoman Sadie Weiner said, “and they should stop trying to bribe Democrats to override the governor’s veto and submit their counterproposal.” .

“Republicans are demanding that access to health care be taken off the table as a precondition to negotiate. Gov. Cooper has offered a comprehensive response to the Republican budget, while Republican leaders continue to sound a one-note rejection,” Weiner said.

She said that while “Cooper has not issued an ultimatum on any issue, Republican leaders continue to insist that he has.”

“Instead of negotiating, Republican leaders have spent their time recklessly and irresponsibly auctioning off the headquarters for the Department of Health and Human Services, cynically risking vital jobs and services, to any Democrat who will join them to override the governor’s budget veto.

“Republicans do not have the votes to override this veto, and with each passing day they are disrespecting North Carolinians who voted for more balance in government,” Weiner said.

“They are running out of fig leaves to hide their true intentions.”

Waiting for right time

House Speaker Tim Moore, R-Cleveland, told reporters after the July 8 session — the first session to skip a vote — that “we’re going to wait until the time is right.”

Berger has said the Senate is inclined to stick with its plans to adjourn the current session Monday and to reconvene Aug. 27 for a limited session. However, Moore has said the House not is likely to follow the same timeline.

Berger said, “We will continue to have negotiations with the House” on an adjournment date.

“The speaker has some expectations that an override will take place, and I am hopeful that is the case,” Berger said.

“We have been here a while and I don’t know that it makes a lot of sense for us to keep people here for an indefinite period of time.”

Kokai said GOP legislative leaders “still seem to be in the mode of recruiting Democratic votes for a budget veto override.”

“As long as that effort continues, the likelihood of intensive negotiations with the governor’s office appears remote.”

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