A MARTÍNEZ, HOST:
In North Carolina, about 600,000 residents will soon be eligible for health insurance coverage through the Affordable Care Act. The state became the 40th in the country to fully expand Medicaid, and that was approved by a Republican legislature. Colin Campbell of member station WUNC in Raleigh reports more red states could follow North Carolina.
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ROY COOPER: We have a Medicaid expansion bill.
COLIN CAMPBELL, BYLINE: Democratic Governor Roy Cooper held an outdoor bill signing Monday afternoon in the gardens of the governor's mansion. Republican state House and Senate leaders stood beside him as he signed the bill into law.
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COOPER: And thank you to the Republican legislative leaders who ultimately approached this issue with a willingness to change their minds to find a solution that worked for North Carolina.
CAMPBELL: For more than a decade, North Carolina's Republicans opposed expanding Medicaid. They cited cost overruns in their existing Medicaid program, and they worried that Congress might repeal the Affordable Care Act and leave states stuck with the bill. Tim Moore is the speaker of the House who had opposed expansion.
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TIM MOORE: For years and years, we resisted expansion because we saw the prospects that the state's cost could easily triple, that it could be a runaway budget.
CAMPBELL: But none of that happened. Instead, the federal government sweetened the pot. A big factor for North Carolina leaders is that expansion now comes with a $1.8 billion signing bonus. Paired with another federal program, officials estimate North Carolina will get an $8 billion injection for health care. House Speaker Moore says that makes the math work.
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MOORE: Now it stays within budget.
CAMPBELL: Hospitals say it's a game changer in a state where many rural hospitals are struggling, and some have closed. Nicholle Karim is with the North Carolina Healthcare Association.
NICHOLLE KARIM: This money is going to be a lifeline for hospitals.
CAMPBELL: And while North Carolina Republicans changed their minds on fully embracing Obamacare, ten other GOP-dominated states continue to be holdouts. Most are in the South, including Florida, Alabama and Mississippi. Political scientist Chris Cooper with Western Carolina University says that could change.
CHRIS COOPER: I think it makes sense that some of our neighboring states might look at North Carolina and see, hey, you can change your mind, and you can still keep your electoral fortune.
CAMPBELL: He points to other Republican states like South Dakota, where voters decided to expand Medicaid.
COOPER: So this is the rare kind of issue that's becoming less partisan over time.
CAMPBELL: Those who want to take advantage of the Medicaid expansion still have to wait a few more months. The law takes effect only after the state enacts its annual budget. That's expected to happen this summer.
For NPR News, I'm Colin Campbell in Raleigh. Transcript provided by NPR, Copyright NPR.