By Rose Hoban
In a dramatic turn of events early Wednesday morning, House Republicans successfully held a vote to override Gov. Roy Cooper’s veto of the state budget when few Democrats were in the chamber to vote against the measure. (See box.)
The vote means now the budget override moves to the Senate chamber, where Republicans hold a majority that requires them to only peel off one Democratic vote in order to override Cooper’s veto. A handful of gubernatorial vetoes have already been overridden by the Senate, only to be sustained in the House, where Republicans need to capture at least seven Democrats to get to 72 votes, enough to thwart the governor.
As reported in multiple outlets, House Democrats cried foul Wednesday over the budget override vote taken by the Republican majority in the House of Representatives.
As Speaker Tim Moore (R-Kings Mountain) called for the vote a few minutes into the 8:30 a.m. session, Democrats jumped up to object, with Rep. Deb Butler (D-Wilmington) yelling, “I will not yield,” even as Moore cut off her microphone.
Only about a dozen Democrats were in the chamber, while Republicans had at least 55 members present, which satisfied the requirement for a 61 member quorum. The vote was 55-9 in favor of an override.
Democrats argued they had believed there would be no votes during Wednesday’s morning session. House Rules Chair David Lewis (R-Dunn) and Moore both argue they never said there would not be budget votes taken Wednesday morning.
Minority leader Darren Jackson (D-Raleigh) said it was his understanding from a conversation held with Lewis on Tuesday afternoon that the legislature would take no votes at all Wednesday morning. His legislative aide sent an email to Democratic members to that effect, resulting in one side of the chamber being almost empty.
Now as the budget bill moves to the Senate for their override attempt, Cooper’s leverage at using the budget to force discussions on Medicaid has potentially been dealt a mortal blow.
Cooper said since the start of this legislative session in February that he wanted to see the General Assembly use the ability created in the Affordable Care Act to extend Medicaid coverage to as many as half a million people. These are mostly low-income workers who make too much to qualify for the program, but who also make too little to qualify for subsidies for coverage in the Obamacare health insurance marketplace.
When he vetoed the budget passed in late June, Cooper tied Medicaid expansion to any budget agreement, and the governor and the legislature have been in a standoff over the two issues which have become closely intertwined.
Now with the budget veto override over its most difficult hurdle, the path forward for any sort of Medicaid expansion has become more challenging.
Tweaks and tucks
The legislature wrested control over making any decision around Medicaid expansion back in 2013. Since then, Democrats have filed multiple bills for expansion which quickly died.
Legislative Republicans have been staunchly resistant to adding more people to the Medicaid rolls. In particular, Senate leader Phil Berger (R-Eden) has said multiple times he is uninterested in allowing an expansion to come to a vote in his chamber.
But supporters of expansion felt like they finally had their opening after Democratic gains in the 2018 elections broke Republican super-majorities in both the House and the Senate. Advocates hoped Cooper’s veto this summer would force Republicans to the negotiating table to talk about some way forward.
Publicly, legislative leaders and the governor have traded barbs and testy press releases over Medicaid and the budget. Multiple sources say that there has been some quiet back and forth on what form of Medicaid expansion might be acceptable.
Rep. Donny Lambeth (R-Winston-Salem) has continued to push for using Medicaid to extend health insurance coverage to low-income workers. After Wednesday’s contested House vote, Moore said he would honor his prior commitment to have a vote on Lambeth’s Health Care for Working Families Act, which has 21 Republican co-sponsors.
On Wednesday, however, Lambeth asked Moore to wait until next week to run that bill, as he tweaks the bill to appeal to more Republicans.
House Bill 655 would expand Medicaid while adding a small monthly premium and a work requirement for some beneficiaries. The program, usually reserved for low-income children, some of their parents, people with disabilities and low-income seniors, would add people who earn less than $35,535 for a family of four. Caregivers, students, people who are in drug treatment programs and those with medical conditions would be exempted from the work requirement.
Lambeth said he’s recently been tweaking the bill to make it more palatable to his Republican colleagues.
“Last week while we were on break, I worked with the staff that have helped me on this,” he said Wednesday afternoon. One change he’s been making is to make it so that more people would qualify for subsidized coverage on the exchange.
“My Senate colleagues talked about utilizing the exchange, because that is an option,” he said. “I was working toward an amendment on the floor, something that we would do when that bill came back up. And I told the staff, ‘Got a little time, probably another week,’ and I met with them as recently as yesterday.”
“I did not anticipate that I would need to get that done so soon.”
Lambeth said it’s probably not a bad thing to give it a few days, as emotions have been running high in the wake of the morning’s vote.
“You know, obviously the Dems are upset today with the events, and whether they will support this as an alternative to basic expansion is a question,” he said. “I don’t know the answer to that.”
For the bill to pass, it needs almost unanimous Democratic support plus a handful of Republicans to come along.
Lambeth and his co-sponsor Rep. Donna White (R-Clayton) said they would be whipping the votes as much as they could in the coming days.
White said she was “cautiously optimistic,” with an emphasis on “cautiously.”
Senate wild card
The razor-thin margin of error for Democrats in the Senate had health care advocates concerned on Wednesday. Only one Democratic defection is sufficient to give Republicans the 30 votes they need for an override in their 50-person chamber.
“Obviously the big thing that’s changed is the status of the budget,” said Rob Thompson, deputy director of NC Child, an advocacy organization. “If the senate moves forward and overrides the governor’s veto of the state budget, then there’s a lot less political pressure on senators to negotiate and work on [Lambeth’s] bill.”
The budget bill also contains several poisoned pills for the Department of Health and Human Services, namely a nearly $70 million budget cut over the coming two years and an initiative to move the department out of Raleigh and to Granville County.
“The budget and the House vote process are profoundly disappointing,” said HHS Sec. Mandy Cohen in a press release Thursday. “In a time of a surplus, this budget makes massive cuts to DHHS that will potentially impact everything from health inspections of restaurants to the safety of drinking water to child protective services.”
“I think both of those things, the cut and the move, if enacted are going to be really damaging to our state’s ability to manage its health care and public health system,” Thompson said.
He noted that Berger has said some “more positive and open statements,” of late. But he also worried that without the pressure of the budget standoff, Berger has less incentive to allow for Lambeth’s bill to come to a vote, should the House pass it and send it to the Senate.
Who’s on board?
People around the legislative building were counting their fingers all day, trying to discern if there were any senate Democrats who might cave to pressure applied by the Republican leadership.
Sen. Don Davis (D-Greenville), who sided with the Republican majority on a contentious abortion bill earlier this year, told numerous reporters that he would be a reliable vote to sustain Cooper’s veto. Similarly, Sen. Floyd McKissick (D-Durham) said he was confident in a vote to sustain.
“I’ll put it like this. I think the governor’s veto will be sustained without a doubt,” McKissick said.
“I know they’re going to twist arms but we’ve talked as a caucus throughout this process and again today, and we’re going to hold firm,” assured Durham Democratic Sen. Mike Woodard.
But members of the Republican majority expressed their own confidence that their side would prevail.
“The question is when,” said Sen. Ralph Hise (R-Spruce Pine).
“We have made the offer to the governor, to come to a special session to discuss changes to Medicaid,” he said. “Don’t know that that offer has changed. And we have always said that the discussion of changes to the Medicaid, its population … has to be separated from the budget conversation in order to move forward.”
And should the budget veto fall in the Senate?
“It’s hard to see a political landscape where the Senate would stick around to have that [Medicaid] vote,” Thompson said.
Update: This story has been updated with a comment from DHHS which was sent Thursday.
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Gee, looks like this article left out a few salient issues – like the fact that the gop lied to both house dems and reporters, posted a schedule indicating there would be no vote, then as soon as most dems were gone, notified gop house members only that a vote was impending. So they lied, manipulated, and purposefully subverted the democratic voters – again showing how corrupt and absolutely bottomless they are. Self-serving and power-hungry, they have nothing but contempt for democracy.
This ridiculous, slanted article makes it seem like some sort of political triumph and leaves out most of the relevant story.
As noted and linked to, many other outlets described Wednesday’s events in exhaustive detail. That’s not our role here. Instead, we consistently look at events through the lens of how such events affect health policy in North Carolina, and so, the story is our analysis of how Wednesday’s events might affect the Medicaid debate.