House Bill 149, Expand Access to Healthcare, does more harm than good for healthcare access for the most vulnerable North Carolinians. Civitas Action believes the vote for freedom is a vote NO on HB149.

Expanding the state’s Medicaid system to able-bodied, working age adults sacrifices healthcare access for the low-income children, parents, and individuals with disabilities that the program was created to serve. Moreover, increasing government dependency by expanding an already bloated and fraud-riddled government program is the opposite of defending freedom.

With record high inflation and a recession looming, Medicaid expansion poses risks to the state’s fiscal health and economy, including:

  • Ballooning the long-term state taxpayer obligation for Medicaid, which already comprises a considerable portion of the state budget, by adding over 600,000 enrollees.
  • Creating a disincentive for work or career advancement by implementing a “welfare cliff.” Work requirements in the bill are unlikely to be accepted, as we have seen in other states.
  • Decreasing the pool of North Carolinians in private insurance, thus increasing hospitals’ reliance on low Medicaid reimbursement.

Civitas Action supports other healthcare changes in this bill, including reducing the state’s burdensome Certificate of Need requirements, expanding practice authority for advanced nurses, and requiring notices for out-of-network bills. However, Medicaid expansion will have an impact on our state’s healthcare landscape, budget, and economy disproportionate to the benefits advanced by the bill’s other provisions. Civitas Action would support this bill if the Medicaid expansion and telehealth coverage parity provisions were removed.

North Carolina needs a long-term vision for healthcare that opens private markets and reduces, not increases, the role of government in providing health insurance and healthcare. Medicaid expansion harms healthcare access for the program’s intended beneficiaries and outweighs the positive policy changes in this bill. For that reason, Civitas Action believes the vote to defend freedom is a vote NO on HB149.

Civitas Action will grade the second reading floor vote on any version of this legislation containing Medicaid expansion in the House or Senate.

The Civitas Action Freedom Rankings can be found at

Civitas Action is a 501(c)(4) non-profit that educates and informs North Carolinians on policy issues and the actions of their elected officials.