Gov. Roy Cooper’s office said Tuesday the governor will stress that expanding Medicaid be included in any state budget compromise submitted by Republican legislative leaders.

However, an administration official indicated it is too early to say whether Cooper would veto a compromise budget plan, even though a key GOP leader claims Cooper’s office won’t conduct budget negotiations without expansion.

The expansion would affect 450,000 and 650,000 North Carolinians, experts have said.

Officials in Cooper’s office began negotiating with House and Senate budget writers shortly after the Senate passed its version of House Bill 966, the budget bill, on May 31. Neither plan contains Medicaid expansion.

Cooper spokesman Ford Porter said Tuesday “it should be no surprise that the governor is pushing for Medicaid expansion in budget negotiations, which we expect to continue. We are in the infant stages of these negotiations.”

“Instead of trading letters through the press like a political TV drama, we hope Republicans will engage in a meaningful conversation with the governor.”

The office of Sen. Harry Brown, R-Onslow, said Tuesday that Cooper administration officials informed GOP legislative leaders “that they would not negotiate on the budget until legislative budget writers agree to include Medicaid expansion in the budget.”

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.

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.

Rep. Debra Conrad, R-Forsyth, said the budget compromise could be reached before the Fourth of July legislative break.

“We do not expect Medicaid expansion to be included,” Conrad said.

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.”

Expansion debate

Brown said in a statement 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.”

Brown said Cooper “should ... come back to the negotiating table to work with the legislature on a budget that delivers on important priorities for the citizens of North Carolina.”

Brown cited a recent Charlotte Observer editorial that while defending Cooper insisting on Medicaid expansion, it said such language should be negotiated in a separate bill, and not in the state budget.

However, the Republican-controlled legislature has yet to act on any Medicaid expansion bill, whether the two submitted by Democrats or House Bill 655, sponsored by state Rep. Donny Lambeth, R-Forsyth, which includes a work requirement for some recipients and has bipartisan support.

The decision by Cooper to 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.

Cooper could also choose to veto the Republicans’ compromise budget bill to highlight disagreements over public education and environmental issues as well.

“With their budget, Senate Republicans once again prioritize more corporate tax cuts at the expense of public education, clean water and providing affordable health care for hard working North Carolinians,” Cooper’s office said when the Senate budget was approved.

“These are unacceptable priorities, and Gov. Cooper will continue pushing for a budget that represents middle class families instead of special interests and corporate shareholders.”

No super majority

The ending of the GOP super-majorities in both chambers is likely to give Cooper leverage with GOP legislative leaders and with who might be on undecided.

“The veto being sustained (in the Born-Alive abortion legislation on June 5) was the sign of a change in the balance of power in our state that we hadn’t yet seen realized in legislative debates,” said Brendan Riley, policy analyst with left-leaning N.C. Justice Center.

“It’s long past time for lawmakers to close the coverage gap for the uninsured in North Carolina, and the governor has made that priority very clear.”

Medicaid expansion has been brought up by state Senate leader Phil Berger, R-Rockingham, only when he cited that the state is picking up $141.3 million in reduced N.C. Health Choice federal funding. The federal match in the program drops to 88.4% in fiscal 2019-20 and just under 77% in 2020-21 (preliminary number).

Berger has said for years that his primary opposition to Medicaid expansion is his concern that the federal government may chose not to keep up its 90% funding of additional administrative costs.

A statement from Berger’s office said that “while Democrats have focused their efforts on expanding socialized medicine via Obamacare Medicaid expansion, Republicans believe that care for people with severe disabilities should be prioritized over taxpayer funding for able-bodied adults.”

Conrad said she “agrees with the sentiment that the governor should not use the single issue of Medicaid expansion for able-bodied adults as his excuse to veto the budget.”

The N.C. Justice Center released last week a report that claimed 54,000 individuals with disabilities "stand to gain coverage under Medicaid expansion — that’s nearly one in seven of the uninsured who’d benefit."

"Advocates for people living with disabilities, as well as those with chronic illnesses and complex medical needs, have signaled support for closing the coverage gap. They clearly recognize that people with disabilities stand to gain from Medicaid expansion. Disability Rights NC and 28 other organizations issued a joint statement to that effect."

Test of budget wills

Riley said he believes the House and Senate budget plans “are deeply flawed, prioritizing tax breaks for corporations and the wealthy at the expense of top priorities for all North Carolinians, such as health care and education.”

“Closing the coverage gap must be a part of the final budget package.”

Mitch Kokai, senior policy analyst with Libertarian think tank John Locke Foundation, said the governor’s Medicaid expansion stance “seems to set the stage for a lengthy stalemate.”

“Senate leaders’ opposition to Medicaid expansion represents more than a bargaining chip or partisan gamesmanship. They have a deep-seated philosophical objection to expanding the program in the way the governor proposes.

“Unless Gov. Cooper can come up with something other than campaign-style photo ops and outdated stump speeches to make his case, expansion is going nowhere.”

John Dinan, a political science professor at Wake Forest University and a leading expert on state legislatures, said that “it was always clear that the governor would veto a budget that did not include Medicaid expansion.”

“The question is whether Republicans can negotiate a deal with a few Democratic legislators to override the veto ... if they saw enough else in the budget that they liked.

“Or, whether we are in for a long battle this summer to see who blinks first: the governor or the legislature.

“We are in much more polarized times in 2019, and it has become much more difficult in intervening years for legislative Democrats to stray from their party and override a veto,” Dinan said.

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