RALEIGH, N.C. (AP) — North Carolina Democratic Gov. Roy Cooper was blocked from expanding Medicaid in his first term by Republicans in the legislature, and any repeated push could again face more stalemates with the GOP after the status quo election results of November.
Now shifting to his second term, Cooper is unveiling a high-powered bipartisan blue ribbon commission he hopes will plow aside acrimony with the still Republican-controlled General Assembly and improve health care access through consensus legislation in 2021. The extended COVID-19 pandemic also has made coverage gaps more acute with job losses and illness.
“I think that there are core principles that we can agree to, like the fact that more people in North Carolina deserve health insurance,” Cooper said in an interview this week with The Associated Press. “This is not just purely a Medicaid expansion issue."
The North Carolina Council for Health Care Coverage, which holds its first meeting Friday, includes big names from North Carolina health care, business, nonprofits and state government from both sides of the political aisle. The council will be convened by the Duke-Margolis Center for Health Policy at Duke University, whose leader worked in both Republican and Democratic presidential administrations.
The three-dozen members include the heads of Blue Cross Blue Shield of North Carolina and associations representing hospitals and physicians, as well as the presidents of the North Carolina Chamber and N.C. Retail Merchants Association, according to a list provided by Cooper’s office.
Perhaps most telling: the list shows more Republican legislators than Democrats. They include GOP senators who've been chronically opposed to expanding Medicaid to hundreds of thousands of able-bodied residents lacking insurance through President Barack Obama's 2010 health care law.
House Majority Leader John Bell, a Wayne County Republican, accepted the Cooper administration's invitation to participate. But he warned he would have better things to do if the panel is “a dog-and pony show and push for Medicaid expansion."
“If this is about a way to advance health care issues for the people of North Carolina,” Bell said on Thursday, ”I’m willing to see what we can get done."
Cooper won reelection in November but failed with fellow Democrats to take back majorities in the General Assembly, which if successful would have likely secured the passage of expansion he's sought since 2017.
North Carolina is one of a dozen states that haven't accepted expansion, which would require it to pay 10% of coverage costs. Some House Republicans have been more willing to consider an expansion that contains monetary or work requirements.
Pat Ryan, a spokesman for Senate Republicans, pointed out that Republicans proposed to Cooper in 2019 a special session to discuss health care access. “So it’s an encouraging sign for progress on this front that the executive branch appears to be open to ideas other than traditional, all-or-nothing expansion,” Ryan wrote in an email.
Cooper said voters decided in November that they wanted divided state government. He said he's already had many conversations with Republican leaders since the election to try to avoid impasses like the one in 2019, in which a traditional two-year budget was never approved in part to differences on expansion.
“I believe that there is a real effort on the other side and from my office and some Democrats in the legislature to come at this from a different perspective," Cooper told the AP.
The council will finish its work by the end of January, when the General Assembly begins its session in earnest. The goal is to provide recommendations on where consensus is possible, or “at least some path forward that we can all agree to,” Duke-Margolis Center director Mark McClellan said.
The tentative agenda for Friday's virtual meeting is heavy with presentations on Medicaid and Medicaid expansion. But Cooper and McClellan were careful not to present the council as one seeking a predetermined outcome.
“All options are on the table for expanding health care access to people,” Cooper said.
The governor did mention interest by some in reforms to “certificate of need" laws for new medical facilities and in ways small businesses can seek affordable employee group health insurance.
McClellan, a Medicare and Medicaid administrator and Food and Drug Administration commissioner in George W. Bush's administration, said the state's shift to managed-care benefits for Medicaid recipients — long-delayed but starting next year — is a symbol of what can be accomplished.
The council is "off to a good start, given that the breadth of perspectives that are willing to give this a try,” McClellan said. But he added: “I don’t want to make it sound like this is going to be easy.”