Why North Carolina Republicans Finally Agreed to Medicaid Expansion

Demonstrators supporting Medicaid expansion in 2013. (Photo by Joe Raedle/Getty Images)

Republican support for Medicaid expansion in North Carolina was almost unthinkable a decade ago. Thom Tillis, then the speaker of the state House, guided a bill to passage in 2013 that blocked any future governor from unilaterally expanding Medicaid, an effort he touted during his 2014 U.S. Senate campaign as “fighting against Obamacare.”

But North Carolina Democratic Gov. Roy Cooper signed a Medicaid expansion bill Monday that enjoyed broad and enthusiastic support from the state’s Republican majority: House members even violated parliamentary protocol to give the bill a rare standing ovation as they sent it to the governor’s desk.

While other right-leaning states have expanded Medicaid through ballot initiatives or executive action, North Carolina is the only state to do so with GOP lawmakers leading the way—a sign that after more than a decade fighting Democrats, Republican resistance to Obamacare may be on its last legs.

Medicaid expansion: a primer.

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