A Healthier North Carolina
On December 4, 2024, Governor Cooper celebrated nearly 600,000 enrolled in Medicaid Expansion and other major health care accomplishments, including relieving medical debt, investing in mental health and pioneering new approaches to care.
Remarks as prepared:
Good morning. Thank you Secretary Kinsley. Thank you Dr. Waldrum and ECU Health and Dr. Coward for hosting us today. Darcy — thank you for sharing with us today. Your story and those of many others helped get Medicaid Expansion enacted into law. And now your story is helping others to get enrolled. Thanks everyone for being with us to mark this very exciting milestone — one year of Medicaid expansion in North Carolina with nearly 600,000 people enrolled already — the number of people we had hoped to get in 2 years. That’s the result of a lot of hard work, but it also shows it was something people desperately need.
As I reach the end of my time as Governor, I hold close to my heart the mission of getting people healthier. And I knew getting Medicaid expansion passed and signed into law was the most important thing we could do to accomplish that. But of course it was never a given that we would be able to get Medicaid Expansion. It’s story that took many twists and turns, and through all of them, we knew we could never, ever give up. And we didn’t.
I went from getting sued by the legislature in federal court for trying to expand Medicaid in my first week in office to welcoming those same Republican legislative leaders to the mansion on a beautiful spring day in 2023 to sign the Medicaid Expansion bill we asked for. Talk about climbing a tall mountain!
But the bill wasn’t about them or me. Medicaid expansion was always about the hardworking North Carolinians who desperately needed and deserved access to health care. On December 1st of last year, when Medicaid expansion went live, our state made a bold step that will have a positive impact for generations to come.
For the rest of my life, I will never forget being in Charlotte that day to give a woman named Penny her brand-new health insurance card. She was the very first in the state to get one. There were tears in her eyes, and in mine too. Her path to health insurance had been long and painful.
For years, she and hundreds of thousands of other working North Carolinians had been waiting, hoping and praying that our state would just say yes to expansion. And for so very long, we had been fighting to take this monumental step. As I said on the day enrollment went live — this was a dream a decade in the making that finally became reality.
It also unlocked more than $830 million in new investments in mental health and addiction treatment that we know go hand in hand with staying healthy.
That nearly 600,000 people have already enrolled just one year later is a remarkable accomplishment. And I’m grateful to our NC DHHS and all of the partners around the state who got the word out and got people signed up in all kinds of ways. We wouldn’t be at this successful moment without all of you. Thank you.
When I took office 8 years ago, I put forth my CEO mission. I wanted a North Carolina where people are healthier and better educated, with more money in their pockets. That mission summed up the driving force behind every part of my administration, in whatever area they happened to work.
And Medicaid expansion really moved the needle on all three. People need to be healthy in order to get educated and to work at good jobs to make money for their families.
And while Medicaid Expansion looms large as a major accomplishment in these last 8 years, we’ve made tremendous progress on improving the health of our state through other innovative, cutting edge ideas.
Take our Healthy Opportunities Program. A first in the nation effort to recognize that health care doesn’t just happen at the doctor’s office or in a hospital. We recognized that some Medicaid recipients had needs that if addressed would make them healthier, but that Medicaid wasn’t allowed to pay for even if it saved money in the long run. So we did something about it.
North Carolina got approval to pilot the Healthy Opportunities program and use Medicaid dollars for non-health care expenses that would both save money and improve people’s health. Instead of an Emergency Room visit every month for an asthma attack, why not replace the moldy carpet in your home or install a new air conditioner if the old one’s making you sick. Instead of missing medical appointments because you couldn’t get a ride, let’s pay for your transportation so we can keep you healthy and out of the hospital. Instead of telling you to eat healthy food, let’s deliver it to you.
People stay healthier, and the state saves money in the long run. This effort started under then-DHHS Secretary Dr. Mandy Cohen and continues under Secretary Kinsley. To date, North Carolina has served more than 26,000 high-needs Medicaid enrollees to keep them healthier and prevent illness rather than just waiting to treat it.
Also high atop our innovations is our first in the nation solution to get rid of medical debt. As Medicaid expansion reached more and more people, it was clear that they were happy to finally have health insurance but often had a mountain of hospital bills they could never pay.
This debt was not a choice. It kept them from getting credit cards, buying a home and even sometimes from getting a job. Most were honest people who were deeply distressed about owing money they couldn’t afford to pay. It also often made people less likely to see a doctor when they needed one, even when they now had insurance, because they were afraid of the debt.
So together with feedback from hospitals and national experts, Secretary Kinsley helped lead our effort to craft a pioneering solution that relieves $4 billion in medical debt for 2 million North Carolinians — a plan that’s now a roadmap for other states who’ve asked us how we did it. Getting rid of medical debt will allow Medicaid expansion to live up to its fullest potential and its greatest promise.
And we got there on all of it — Medicaid expansion, medical debt relief, Healthy Opportunities and so much more — we got there because we never stopped believing that our work could make a difference. No matter how many doors were slammed in our face. Or how many people thought we didn’t stand a chance. We knew that the dream of a healthier North Carolina could become a reality and that we must keep fighting for it.
From the first public university to first in flight, North Carolina has a storied history of innovation that’s powered our people to reach our biggest milestones. And for the last eight years, it’s been an honor to lead our state through one health care innovation after another that will have a lasting impact on North Carolinians for generations to come.
Thank you all for your partnership. I look forward to more work together in the future.
