NC Governor Roy Cooper highlights the need for Medicaid Expansion in Yadkinville

Democratic North Carolina Gov. Roy Cooper has wrapped up several days of visiting rural counties to highlight their health care and economic needs and how he says getting Medicaid expansion soon can help with these challenges. 

The message was clear at a roundtable discussion led by Governor Roy Cooper in Yadkinville on Thursday: rural communities need Medicaid expansion now.

It’s a cycle playing out in small towns across the state where people are three to four times more likely to be uninsured, much-needed preventative care and medical treatment are not sought out, patients wind up in the emergency room instead, and small rural hospitals unable to recoup expenses are forced to close their doors.

Such was the case in 2015 with the closure of the Yadkin Valley Community Hospital and, more recently, the Martin General Hospital in eastern North Carolina, which filed for bankruptcy earlier this month.

Governor Cooper says Medicaid expansion — signed in March by the General Assembly with strong bipartisan support and now stalled by budget negotiations — is designed to help. Cooper urged his Republican colleagues to pass the budget allowing access to affordable coverage for those who need it most.

"We live in the greatest and richest country in the world," says Cooper. "We ought to be able to find a way where everybody has health insurance. But right now, with the process like it is, this is a step that we can take to insure 600,000 more North Carolinians, and we need to continue to strive to make sure that more and more people get insured in some way and I’m going to continue fighting to make sure that happens."

Cooper says the state is expecting to receive over a $1 billion signing bonus from the federal government. That money he says will be used for mental healthcare, and addiction treatment which are particularly acute problems in the state’s rural communities.

With lawmakers in Raleigh this week to vote on non-budget legislation, House Speaker Tim Moore and Senate leader Phil Berger said the two chambers are getting closer to a budget agreement, but that it won't be finalized and voted on until early or mid-September.

Kody Kinsley, the secretary of Cooper's Department of Health and Human Services, announced last month that expansion would start Oct. 1 as long as his agency received formal authority by elected officials to move forward by Sept. 1. Otherwise, he said, it would have to wait until Dec. 1 or perhaps early 2024.

As the budget stalemate extended, Cooper has urged legislators unsuccessfully to decouple expansion authorization from the budget's passage and approve it separately. After completing votes Wednesday, lawmakers may not hold more floor votes until early September.

Berger and Moore said they remain committed to getting expansion implemented. Berger mentioned this week that some budget negotiations center on how to spend the one-time bonus money the state would get from Washington for carrying out expansion.

While Moore said Thursday he was hopeful expansion could still start Oct. 1, Berger reiterated that missing the Sept. 1 deadline would appear to delay it.

Cooper's travels took him Tuesday to Williamston, where he toured the grounds of Martin General Hospital, which closed two weeks ago.

Martin General closed its doors after its operators said it had generated financial losses of $30 million since 2016, including $13 million in 2022. Cooper was greeted in Williamston by hospital employees and other supporters who asked him for help keeping the hospital open. The closest emergency room is now 20 miles away.

North Carolina's expansion law would result in higher reimbursement rates for these and other hospitals to keep them open and give an economic boost to the region, according to Cooper's office.

Kinsley has said he expects 300,000 people who already receive family planning coverage through Medicaid will be automatically enrolled for full health care coverage once expansion begins.

And Cooper said it should also return coverage to about 9,000 people who each month are being taken off the rolls of traditional Medicaid now that eligibility reviews are required again by the federal government following the end of the COVID-19 pandemic.