RALEIGH, N.C. (WNCN) – After years of frustration, Han Setiawan said he felt hopeful this week when the state Senate voted to expand Medicaid coverage in North Carolina. 

He used to live in Michigan, that made that move several years ago. His family is low-income and fell into the healthcare coverage gap. But, with Medicaid expansion, they were finally able to afford healthcare. He said it happened just in time. 

“My father had to have some heart surgery and thankfully because of Medicaid expansion, we were able to afford that. It was a huge bypass surgery,” he said. 

His mother’s cancer also returned and had spread. 

“Those cancer immunotherapy drugs are expensive if you have to pay out of pocket,” he said. 

Setiawan moved to North Carolina to study at Duke University. His parents wanted to come, too, in order to be near him.  

But, North Carolina is among 12 states that has not expanded Medicaid under the Affordable Care Act. If Setiawan’s parents came here, they’d lose their coverage. 

“That’s why they decided to remain in Michigan. They would love to be with me in this state,” he said. “Yeah, it was very, very difficult. But, at the end of the day, as a low-income family, we really couldn’t afford paying things out of pocket.” 

This week, the Senate voted nearly unanimously on a bill that would expand Medicaid coverage to approximately 600,000 people in North Carolina. It marked a major shift on the part of the chamber’s Republican leadership who for years have fought to do that. 

Senate leader Phil Berger (R-Rockingham) said he no longer has the concerns he once did about the move negatively impacting the state budget and now thinks it’s “good state policy.” 

Republican leaders in the state House of Representatives don’t see it that way. 

“The bill that they passed as they passed it? No. Because they had a lot of stuff in there added to it,” Speaker Tim Moore (R-Cleveland) said following the Senate vote. 

The bill that passed includes a variety of provisions Republicans said are aimed at increasing access to healthcare, some of which have been priorities for them for several years. Those include: provisions to address surprise medical billing and transparency, giving advanced practice nurses greater ability to practice outside the supervision of a physician (known as the SAVE Act), certificate of need law reforms and telehealth regulations. 

The North Carolina Healthcare Association, that represents hospitals in the state and has advocated for Medicaid expansion, said the group is “deeply concerned” about parts of the bill, calling some of the language “troubling.”  

“North Carolina’s health systems and hospitals remain deeply concerned about proposed modifications to the current Certificate of Need law included in the bill. The ultimate goal of Certificate of Need programs is to use data-driven need methodologies to equitably distribute healthcare services across the state while ensuring quality services,” NHCA said in a statement.

The statement continued, “Hospitals do not operate in a traditional free market environment; they have a moral and legal obligation to care for all regardless of the patient’s ability to pay. Modifying the current CON law would hurt the stability of rural hospitals by carving out elective and outpatient procedures which are the lifeblood of community hospitals, while allowing niche medical organizations without such federal regulation to cater to commercially insured patients. In addition to the harmful CON and telehealth policies that will ultimately impact patients, the bill includes yet another tax on hospitals making hospitals one of the highest taxed businesses in the state.” 

Speaker Moore said he doesn’t expect the House will seriously consider the issue until after the November election, as Republicans seek to regain their veto-proof supermajority in the legislature. 

“I think a lot of conversations will be a lot easier seven or eight months from now than they are right now. So, a lot of things aren’t necessarily ‘no,’ they’re just ‘not now,’” he said. 

Conservative groups, including the John Locke Foundation and Americans for Prosperity North Carolina, continue to oppose Medicaid expansion. 

AFP-NC state director Chris McCoy said this week his group has been urging members to call legislators to oppose the bill. 

“A single-payer health care system is not designed to support the individual health needs of Americans. The Senate should focus on reforms that create personalized health care options that better meet the needs of patients, while reducing the government’s role as middle man between patients and medical professional,” he said. “AFP-NC will be activating its grassroots to hold lawmakers who vote for this wrong-headed measure accountable, as well as considering this vote in our legislative scorecard.” 

Kody Kinsley, the secretary of the state’s Department of Health and Human Services, told state lawmakers this week he’s worried about state potentially missing a significant opportunity. The federal government has offered the 12 remaining non-expansion states to cover even more of the cost for the first two years. 

“I see the opportunity to draw down an $8 billion annual investment of recurring federal dollars into health for North Carolina,” he said. “I think we’ve all been in the situation where we found a particularly good travel deal online and we waited until the next day and we lost it. I don’t want to wake up in a few days and feel like we missed this chance.” 

Setiawan is urging state leaders to move quickly too.

He has been advocating for expansion for a few years, working with the American Cancer Society Cancer Action Network. 

His mother passed away last year due to her cancer. He said his father is still in Michigan and hopeful he’ll be able to live near his son. 

“It’s been incredibly frustrating that the state hasn’t really moved on this for years,” he said. “I’ve seen many, many studies about how it brought a lot of benefits to the state of Michigan when they passed Medicaid expansion. So, I would love to see those benefits felt here in North Carolina as well.”