The money is a big factor: With the federal government promising to cover 100 percent of expansion costs through 2016 and 90 percent afterward, refusing the expansion could cost the state $51 billion in federal funds.
Earlier this week, North Carolina Health Secretary Aldona Wos said she would present options for expanding the program, which covers 1.8 million people already. Medicaid expansion would cover another half a million North Carolinians.
McCrory has kept the door open to Medicaid expansion before, assuming, he said, he is able to make reforms to the program as it exists today. In July, McCrory told a radio station expansion would be an option “once we fix the current system.”
But unlike some governors, who were able to expand Medicaid unilaterally through executive actions, McCrory will have to go through the legislature. He signed a measure last year prohibiting the state from expanding Medicaid without legislative consent.
If he decides to go ahead with a legislative push to expand Medicaid, it will set McCrory on another collision course with state Senate President Phil Berger (R), who opposes expansion. A Berger spokeswoman told AP that he has not changed his position.
Although they are both Republicans, Berger and McCrory have had a rocky relationship. They spent their first year working together feuding over tax cuts, the budget and a transportation package, and by the end of a special session last September, they were barely on speaking terms. McCrory aides believed Berger was pushing positions that were too conservative, while Berger aides thought the governor — the former mayor of Charlotte — was out of his depth in Raleigh.
The dynamics could be worse this year, because there is no middle man to conduct shuttle diplomacy. State House Speaker Thom Tillis (R) regularly played that role last year, translating and negotiating between his two fellow Republicans. But Tillis won’t be around to play that role again: He’s running for a U.S. Senate seat and giving up his position in the state capital.
Tillis’s replacement will probably have to play peacemaker. Raleigh insiders say the race for Speaker is likely to include Reps. Tim Moore (R), Leo Daughtry (R), Mike Hager (R) and Nelson Dollar (R).
Twenty-seven states and the District of Columbia have agreed to expand Medicaid, including nine states with Republican governors. Tennessee Gov. Bill Haslam (R) is also considering ways to expand Medicaid.