About 634,000 more low-income North Carolina residents would be covered by Medicaid in 2022 if the state expanded its program under the Affordable Care Act, according to a study by researchers at George Washington University, an issue that has become a fault line in this year’s budget debate. 

Republicans in the General Assembly have declined to include Medicaid expansion in their budget, and have portrayed the issue as a non-starter. Governor Cooper, who for the first time has enough Democrats in the legislature to sustain his vetoes, is insisting that Medicaid expansion be part of budget talks. 

A standoff over the issue in the coming weeks seems likely. 

In addition to giving more people access to health care, the report says, Medicaid expansion will also create 37,200 jobs by 2022. The federal government will cover about 90 percent of the bill, pumping about $11.7 billion into the state between 2020 and 2020, according to the study, which was commissioned by the Cone Health Foundation and the Kate B. Reynolds Charitable Trust.

A little fewer than half of the new jobs would be in Durham, Buncombe, Forsyth, Guilford, Mecklenburg, and Wake Counties. Most of these jobs would be in the healthcare field, with the rest in construction, retail sales, professional and management services, and other fields.

Economic activity would grow by $2.9 billion in 2022 and increase state and local government revenue by $500 million $100 million, respectively, the report continues.

A 2018 review of more than two hundred studies done by the Kaiser Family Foundation included in the report found that Medicaid increased insurance coverage and decreased the number of uninsured, helping nearly everyone: rural and urban residents, as well as black, white, and Latinx communities. Additionally, expanding Medicaid improved access to health care, extended low-income families’ financial security, enhanced health outcomes, reduced uncompensated care costs, and stabilized safety-net health care providers.

The analysis is an update to GWU’s 2014 report on the economic consequences of not expanding Medicaid in 2014. That study estimated that, by failing to expand Medicaid, North Carolina lost access to billions of federal dollars, forty-three thousand new jobs by 2020, and other economic opportunities.

North Carolina is one of fourteen states—all of which voted for Donald Trump—that hasn’t expanded its Medicaid program under the Affordable Care Act, and only eight states have stricter income-eligibility requirements for the insurance program.

Cooper has been pushing to expand Medicaid eligibility from 42 percent of the poverty line for parents to 138 percent for those age nineteen to sixty-four, including low-income people without dependent children.

The General Assembly’s budget, a compromise between the conservative House and even more conservative Senate—the House passed its first of two readings Wednesday night, with three Democrats joining sixty-three Republicans in voting aye—is likely to be vetoed, and Cooper likely has the votes to make that veto count. 

Senate leader Phil Berger and House Speaker Tim Moore have blamed Cooper for the deadlock. That might be a good argument for them.

On the other hand: 634,000 more low-income people with access to health care; 37,200 new jobs; almost $3 billion in economic activity and $500 million in additional state revenue. 

The state has until July 1, the start of the next fiscal year, to get its budget in place. That’s Monday. 

Comment on this story at backtalk@indyweek.com. 

Support independent local journalism. Join the INDY Press Club to help us keep fearless watchdog reporting and essential arts and culture coverage viable in the Triangle.