GOP leaders tie Medicaid expansion to casinos in stand-alone bill

North Carolina House Speaker Tim Moore, R-Cleveland, speaks with reporters on the House floor...
North Carolina House Speaker Tim Moore, R-Cleveland, speaks with reporters on the House floor of the Legislative Building in Raleigh, N.C. (AP Photo/Gary D. Robertson).(Gary D. Robertson | AP)
Published: Sep. 19, 2023 at 3:14 PM EDT|Updated: Sep. 19, 2023 at 6:35 PM EDT
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RALEIGH, N.C. (AP) - Republican legislative leaders pressed forward Tuesday with maneuvers that could by week’s end approve a long-delayed state budget, begin Medicaid for several hundred thousand low-income adults, and multiply legal gambling through video gaming machines and new casinos.

However, through one effort to tie gambling’s fate with Medicaid expansion, Republicans could potentially scuttle a landmark health care deal they had reached earlier this year with Gov. Roy Cooper, prompting the Democratic governor to decry what he called “the most brutally dishonest legislative scheme” he had seen while in state politics.

House Speaker Tim Moore told reporters that plans were in place in his chamber to vote on two separate bills, and he expected the same this week in the Senate.

But Senate leader Phil Berger’s comments later Tuesday were restrained, saying that negotiations were ongoing with the House and that the two-bill option and its contents were being considered.

“I think it’s more likely than not that we will get resolution this week,” Berger said.

One of the two bills proposed by House Republicans would be a standalone state government spending plan for the next two years, while the other would contain additional gambling. But the gambling measure also would contain language that would allow Medicaid expansion to begin. That’s a twist from six months ago when an expansion law signed by Cooper stated that enacting a budget law later in the year was the required trigger for expansion to start.

The budget is now 2 1/2 months overdue, and an effort by Berger and others to insert the authorization of four casinos and video gambling in the spending plan got derailed last week by significant opposition from House Republicans. That resistance, Moore had said, would prevent his chamber from passing that budget.

Based on the new strategy, Moore said he was confident there were enough votes in his chamber from both parties to pass a budget that leaves out casino and video gambling and override any Cooper veto. But Moore was unsure about the outcome of the bill that now ties Medicaid expansion to casinos and video gambling machines. When combined, that bill could fail or lack enough support to overcome a veto.

“The state budget bill will move forward whether the first bill (gambling and Medicaid expansion) passes or not,” Moore told reporters. “It doesn’t worry me or bother me if that bill comes to the floor and if it doesn’t have the votes, then it simply doesn’t have the votes.”

Moore said that would mean expansion wouldn’t go forward after all - a dramatic result given that he and Berger had willed the expansion bill into law in March after Republicans were opposed to the idea for years.

There are still legislative Republicans opposed to gambling, and Cooper and nearly all Democrats in the General Assembly on Monday said they wouldn’t go along with the GOP ploy, arguing it broke the promise Republicans essentially made in March when the expansion law was signed. Cooper has made expansion one of his top priorities since taking office in early 2017.

“Democratic legislators are rightfully disgusted and strongly oppose this scheme,” Cooper said in a news release Tuesday. “We must keep working this session to get the Medicaid expansion the people of NC were promised.”

Berger said his ultimate goal was to pass legislation that can be passed even if Cooper rejects it.

Moore said talks also continued Tuesday on the details of the gambling measure, which also includes dozens of spending line items that would come from the state’s savings when North Carolina receives a monetary bonus from the federal government for implementing expansion.

The standalone budget, which would spend roughly $30 billion this fiscal year and $31 billion next year, is expected to carry with it a host of Republican priorities. They include deeper income tax cuts and expanding dramatically the program that gives taxpayer funds to families so their children can attend K-12 private schools.

It also will provide teachers and state employees with salary raises, but they’ll fall short of what Cooper sought in his budget proposal.

A House draft of the separate gambling and Medicaid expansion bill released late Monday would initiate the creation of “rural tourism districts” where gambling venues and other development could be built. Three of the four would be in rural counties, while a fourth could be operated by the Lumbee tribe. North Carolina already has three casinos operated by two other Native American tribes.

Video gambling machine operators would be licensed by the state and could place machines at permitted locations, like bars, lottery ticket retailers and at fraternal and veterans’ group halls. Fiscal analyses by General Assembly staff estimated the state’s take from video gambling machines could reach $400 million annually by mid-2028, while a 22.5% excise tax on net casino revenues could mean $200 million annually within five years