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Leprechauns at the Gate! and N. C. Medicaid expansion






Written by Jane Edwards

What happened: When NC Gov. Roy Cooper took over the governor’s office on Jan. 1, he declared his intent to move ahead with Medicaid expansion as a first big policy initiative for NC.   Obama was still in office, so Federal health officials promised to give the state’s expansion request a speedy review – mindful of Trump’s and the Republican-controlled Congress eagerness to pull the plug on Obama’s entire approach to health care reform in which a larger role for Medicaid is a key component.

Then, Senator Phil Berger, President Pro Tempore, NC(R) and Representative Tim Moore, Speaker, NC(R),  rushed to the court of Federal Judge for the Eastern District of North Carolina, (G.W. Bush appointee) Louise W. Flanagan, to enlist her aid in extinguishing Gov. Cooper’s Medicaid Expansion plans. 

Berger and Moore accused Cooper of violating the law passed by NC‘s Republican-led legislature, while Gov. McCrory was still in office, which required any Medicaid expansion to proceed only with legislative approval.  They argued that the state would have to cover part of the expansion (in fact, no more than 10-percent) and that the new governor was unilaterally committing the state to a tax increase (something the governor couldn’t actually do – that’s a legislative function).  

Judge Flanagan accepted Berger and Moore’s non-sensical arguments and obliged the two legislators by issuing a temporary restraining order that kept both Cooper and federal officials from moving ahead with Medicaid expansion for two weeks.

The result: The Trump administration, rather than officials reporting to Obama, have the final call on NC’s Medicaid expansion. This represents a major setback for those seeking better health care access for the poor, and a victory for the conservatives in the legislature for whom holding down taxes has greater importance than the well-being of their constituents – economically-challenged people potentially served by an expanded Medicare program.

NC’s legislators oppose any expansion under the Affordable Care Act, despite the billions of dollars in federal funds and access to health care that expanded Medicaid would bring to the state. Gov Cooper’s efforts to exploit a potential route around the opposition continued as the federally imposed restraining order was set to expire. However, on January 27, Judge Flanagan responded to another stay request from Berger and Moore, now joined by Trump’s Health and Human Services (HHS), and extended the filing date in the case until March 31 (effectively extending the temporary restraining order).  Gov. Cooper could try to negotiate with the new team at HHS; however, it is unlikely that the Trump administration, hostile to all things ACA, would approve of any expansion of Medicaid.

NC’s legislature would rather privatize Medicaid.  Their plan comes from the conservative idea that private businesses are more efficient at managing health care than the government would be.  Just look how well privatized prisons are managed. The fact is, Medicare, by and large, is a fairly efficient program. Seniors manage to get a lot of health care they are happy with for a decent price. Also, there is the biggest unknown with privatization:  whether Medicare – in its current form as a single-payer, guaranteed-coverage, fee-for-service system – will remain intact.      

Gov. Cooper has pointed the way toward a more sensible, humane approach to meeting the health-care needs of NC’s citizens.  If his approach was allowed to proceed, it would be to North Carolina’s credit and advantage.

As for Trump’s promise to leave Medicaid alone? That promise is no more meaningful than a promise to protect swaddling babes from hungry leprechauns.

The cast of villains to this story, if you are interested:

Senator Phil Berger

President Pro Tempore

2017-2018 Session

Republican – District 26

Guilford, Rockingham

N.C. Senate

16 W. Jones Street, Room 2007

Raleigh, NC 27601-2808

(919) 733-5708

[email protected]


Representative Tim Moore


2017-2018 Session

Republican – District 111


N.C. House of Representatives

16 W. Jones Street, Room 2304

Raleigh, NC 27601-1096


[email protected]


Louise W. Flanagan, Judge of the United States District Court for the Eastern District of North Carolina

United States Courthouse

413 Middle Street

New Bern, NC 28560


252.638.1529 fax









SheVille Team

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