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N.C. Rep. Wayne Sasser was among the handful of Republican lawmakers gathered recently for a press conference where House Speaker Tim Moore and Senate leader Phil Berger made history, announcing an agreement to expand Medicaid to additional low-income adults through the Affordable Care Act.

“It’s been a long process and, of course, initially most if not all the Republicans were against it because there were just so many unknowns,” Sasser, a health committee chairman, said last week, noting a major road block was the idea that the state would have to pay for the majority of the expansion.

“The biggest issue was the cost factor,” he added.

Under the agreement, the federal government will cover 90% of the cost of Medicaid recipients under expansion. As many as 600,000 of the state’s working poor, including up to 5,000 people in Stanly County, according to estimates from Stanly County Health Director David Jenkins, would likely receive the benefit. The state’s 10% share will be covered by a new tax on hospitals and insurance companies.

“The state of North Carolina negotiated with the hospitals where the hospitals pay the 10 percent part,” Sasser said.

To illustrate that Medicaid is still a thorny topic for certain officials, Stanly County commissioners, in a 4-3 vote, failed to pass a resolution last week that would have expressed support against expansion.

North Carolina is one of 11 states that has not adopted Medicaid expansion. If the deal goes through, the state would start providing expansion coverage to people starting next January. The plan is for expansion to be tied with the state budget, which will likely not be enacted until at least the summer.

The negotiated measure was built in part on an expansion measure approved by the House a few weeks ago.

If Medicaid is expanded, the state would get an extra $1.8 billion over two years through a COVID-19 federal relief package from Congress for states that hadn’t accepted expansion, Sasser said.

“We’re going to spend at least a billion dollars of that on mental health,” Sasser said, which means more funding for mental health hospitals and treatment facilities for people struggling with substance abuse.

The proposed expansion would also allow the state to receive billions of dollars annually from the federal government. Part of that is from the Healthcare Access and Stabilization Program (HASP) which the state Department of Health and Human Services said can be used to “support behavioral health, public safety support, rural health care, and other needs.”

As part of HASP, Atrium Health Stanly stands to receive $16 million the first year, Sasser said, and then a certain amount every successive year.

“That $16 million is going to be really important for Stanly County,” he said.

Medicaid expansion and HASP will bring $8 billion annually to North Carolina with no additional cost to the state, NCDHHS said.

Besides Medicaid expansion, Sasser said he was optimistic that House Bill 98, known as the Medical Freedom Act, would get approved in the General Assembly, though Gov. Roy Cooper would likely override it. HB 98 would forbid the state from establishing or enforcing COVID-19 vaccine mandates. It also prohibits schools from forcing faculty and staff to be vaccinated.

“Basically what the bill does, it just gives the individual their own choice whether they want to take an unauthorized vaccine or not,” Sasser said.

The county commissioners, by a vote of 6-1, approved a resolution of support for HB 98.

A bill that would legalize medical marijuana in the state is winding its way through the Senate. Sasser said he thinks the Senate will pass it but it will likely fail in the House.

“As a pharmacist and as someone who has worked with the substance abuse issue for the last 10 years, I will be a no,” he said about his position on the bill.

If passed, the measure, known as the North Carolina Compassionate Care Act (Senate Bill 3), would legalize the medicinal use of cannabis for patients with one or more specified qualifying medical conditions such as cancer, ALS, Parkinson’s disease, epilepsy, multiple sclerosis, post-traumatic stress disorder and others.

The bill does not authorize the use of medical marijuana by patients living with chronic pain.