When the Affordable Care Act was passed it contained an option for states to extend Medicaid coverage to adults with an income up to 133 percent of the federal poverty level, beginning in January 2104. To date, 39 states have adopted the expansion, which provides for the federal government to pay 90 percent of the costs to enroll new recipients, with the states responsible for the other 10 percent.

North Carolina debated the expansion initially and determined not to participate for several reasons. The biggest was there was no guarantee that the 90 percent match would be permanent and North Carolina might have to eventually pick up those costs. Also, lawmakers were concerned about North Carolina’s administration of Medicaid and wanted reforms, which they passed. So, nothing happened. Roy Cooper made it a cornerstone issue in his gubernatorial campaign in 2016 and has been prodding our lawmakers ever since.