Medicaid, Budget Fight Test North Carolina Governor's Clout

North Carolina Democratic Gov. Roy Cooper often got steamrolled by Republicans when they held comfortable legislative majorities during his first two years on the job. They could usually ignore his objections about their conservative agenda and override his vetoes.

That's changed since the 2018 elections, when enough Democrats got elected to end the GOP's veto-proof control. Cooper raised millions of dollars for Democratic legislative campaigns, and a court ordered districts to be redrawn in the closely-divided state, aiding Democrats.

The number of Cooper's vetoes has dropped from a record 28 to only two so far this year, a sign that Republicans — still in charge of both chambers — are thinking twice before passing contentious legislation. Democrats united around Cooper by upholding his veto of a "born-alive" abortion measure. And Republicans also so far have held back contentious measures that would require sheriffs to cooperate with federal immigration agents and change how utilities can seek rate increases.

"The election last year had real consequences," said House Democratic leader Darren Jackson of Raleigh. "And it got us back to what I think the founders intended when they set up what they expected would be divided government, and that it would moderate policy. It would force people to talk and try to get things done."

That maxim is being tested in a summer budget stalemate that will determine if Republican legislators finally agree to expand Medicaid under the 2010 federal health care law — something Cooper has sought since taking office in 2017. Republicans so far have failed to override Cooper's budget veto, which would require several Democratic votes. An override likely would make the expansion fight moot for another year.

While North Carolina places no limits on the length of annual legislative sessions, lawmakers usually adjourn around July 4, a few days after the new fiscal year begins. With both Cooper and Republicans accusing each other of not negotiating in good faith, few are predicting how the budget gets resolved, what happens to Medicaid and when legislators go home for good.

"It's hard to say. We haven't put a deadline on it," House Speaker Tim Moore said. "Clearly the budget impasse with the governor has changed things."

Cooper's strategy for expanding Medicaid was built on vetoing the two-year budget June 28. 

He called the budget "an astonishing failure of common sense and common decency." While Cooper has said he also wants the budget's corporate tax cuts deleted, small teacher pay raises improved and school construction funding more secure, the lack of Medicaid expansion is the flashpoint.

"The budget is the place where this needs to be debated and decided," he said July 17, after he listened to uninsured people and their families speaking through tears about their health and financial challenges.

North Carolina is one of 14 states yet to agree to expansion, something that experts say could provide Medicaid coverage to 634,000 low-income adults and reduce the number of uninsured statewide by 365,000. Supporters say expansion would inject money into rural economies and hospitals and make people healthier. Hospitals would pay the state's portion of costs.

Many Republicans don't like increasing what they see as entitlements and they downplay expansion's benefits. But some House GOP members are pitching an alternate expansion plan — a negotiating crack Cooper could exploit.

Still, GOP leaders from both chambers accuse Cooper of holding up a great budget with a "Medicaid-or-nothing ultimatum."

"The governor has made it clear that there is no benefit to talking with him about specific budget items until after Medicaid expansion is passed," Senate leader Phil Berger, an ardent expansion opponent, told reporters.

Cooper says there's no ultimatum, but rather everything needs to be on the negotiating table. When asked whether he could envision accepting a compromise without including Medicaid expansion, Cooper demurred: "You're asking me to try to forecast the end of budget negotiations that haven't even started."

A lot is riding on the outcome. Cooper is seeking re-election next year, and the party that wins a legislative majority in 2020 will get to draw district boundaries for the next 10 years. The impasse hasn't caused a government shutdown, so urgency to end a stalemate may not develop until schools open in August without money for higher salaries and student enrollment growth.

For now, the major players are doing hard-nosed politicking and appealing to the public for support. Moore has visited Wayne County twice to talk up money that the vetoed budget would provide for a local wastewater treatment plant and school construction. On hand was a Democrat he needs to win over for an override.

Cooper, meanwhile, visited Sunday church services in Fayetteville — a beneficiary of budget pork — where he urged parishioners to tell legislators to remain on his side.

Cooper also wants legislators to hear from people like Adrienne Hayes Singleton of Wilmington, who attended his Medicaid roundtable. Married to a disabled veteran, Hayes Singleton is a day care worker and mother of four who doesn't qualify for Medicaid despite making only $1,450 per month. She was floored by a recent $5,000 emergency room bill.

"If I get sick, then my kids suffer, my house suffers, everything suffers," she said, her voice breaking. "I'm just asking to place something in front of me that's affordable, that I can do and I can get it for myself."