In a startlingly decisive step that took place on just the fourth day of his term in office, Governor Roy Cooper announced this morning that he will take immediate action to expand Medicaid coverage to hundreds of thousands of uninsured North Carolinians under the terms of the Affordable Care Act. Cooper’s action, which has long been sought by health care advocates and important sectors in the health care industry, would make North Carolina the 33rd state (including the District of Columbia) to adopt Medicaid expansion. Click here to see the current list.

Cooper’s action seems certain to spur howls of protest from Republican lawmakers and conservative advocacy groups that have long derided Medicaid expansion and the Affordable Care Act (aka”Obamacare”) as “socialized medicine.” Four years ago, at the outset of the administration of Cooper’s predecessor, Pat McCrory, North Carolina legislators enacted a law that purports to prevent the Governor from acting unilaterally to expand Medicaid. Cooper, however, believes that he has authority to act in his role as the state official empowered to craft and negotiate the “Medicaid waiver” plan that North Carolina is currently negotiating with federal officials. It is known that McCrory engaged in conversations with the Obama administration on such a possible move.

In order to underscore his belief that Medicaid expansion will provide an enormous boost to the state economy — particularly in rural areas — Cooper made his announcement at an “economic forecast forum” sponsored by the state Chamber of Commerce and the North Carolina Bankers Association. In his remarks, he stated that expansion would bring $2-4 billion in new investment to the state, create between 20,000-40,000 jobs, lower health care costs for small businesses and public entities and “light a fire” under rural communities while stopping rural hospitals from being “bulldozed.” Cooper also cited the fact that Medicaid expansion has been embraced by a bevy of conservative Republican governors across the country, including Indiana Governor and Vice-President-elect Mike Pence, Ohio’s John Kasich and New Jersey’s Chris Christie. In response to expected criticisms from conservatives, Cooper also pointed out that North Carolinians are “already paying” for Medicaid expansion in those other states and that indigent care is happening now, but in the most expensive and inefficient way possible — i.e. via hospital emergency rooms.

While Cooper noted that 95% of the cost of expansion would come from the federal government, he acknowledged that North Carolina would need to come up with several million dollars in state funds to cover the other 5%. To do this, Cooper suggested the possibility of a straight state appropriation, but also touted the idea of “self-assessment” whereby hospitals — a group he noted would benefit enormously from expansion — contributed the necessary funds.

Cooper’s bold action comes, of course, at a highly confusing and fraught time for Medicaid expansion, and the Affordable Care Act itself. President-elect Trump is pledged to “repeal Obamacare” in the early days of his administration and the new Congress has already been taking steps in that direction as well. That said, there remains enormous uncertainty as to the form any such repeal might take and how it will impact states that have already expanded Medicaid. Add to all this the likelihood that state GOP lawmakers can be expected to challenge Cooper’s action — perhaps even in court — and it would not be an understatement to say that the final outcome of this story is very uncertain. All that said, Cooper’s action this morning was a striking departure from his predecessor and perhaps the strongest indication yet that the new governor intends to “give as well as he gets” in the impending battles with conservative leaders at the General Assembly.

In addition to announcing his bold action on Medicaid expansion, Cooper also pushed strongly for two other high profile policy changes in his remarks. First, he called again on state lawmakers to repeal the state’s controversial LGBT discrimination law, HB2, in its entirety. Noting that such a repeal had only been narrowly missed during last month’s special session on the topic, Cooper stated unequivocally that “the votes are there” for repeal in both houses of the General Assembly. The only roadblock, he stated, was the refusal of Senate and House leaders to allow such a vote on a “clean” bill that includes no delay in the effective date. Cooper, who received applause for his statements on this subject, said he was confident that a bipartisan majority of Republicans and Democrats exists in both houses to take such action. He said that his simple, three-word message to legislative leaders was “let them vote.”

Cooper’s third announcement of the morning was a call for state lawmakers to join him in a plan to raise teacher salaries to the national average in four years. Teacher pay and education funding in general has, of course, been major bone of contention between Republicans and Democrats in recent years. After imposing cuts to funding for several years over loud Democratic opposition, Republicans and Gov. McCrory suddenly embraced the idea of raising teacher pay prior to the 2016 election. Even with the modest bumps provided last year, however, North Carolina teacher pay and overall education funding remain well below national averages. It remains to be seen whether Republicans will express any interest in joining Cooper in this new effort.

Stay tuned to The Progressive Pulse and the main NC Policy Watch website for updates on this developing story.