After helping NC expand Medicaid, Phil Berger now supports the bill that could kill it | Opinion
North Carolina’s most powerful Republican says he supports Donald Trump’s “big, beautiful bill” — even though it could mean the end of Medicaid expansion in North Carolina.
For years, Senate leader Phil Berger stood in the way of expanding Medicaid. Since it officially became law in 2023, it has resulted in 663,000 more North Carolinians receiving health care coverage. But the One Big Beautiful Bill Act, which passed the U.S. Senate Tuesday, could change that.
Here’s the problem: the law that expanded Medicaid in North Carolina contains a provision that would automatically terminate the program if the federal government stops covering 90% of its cost. Analyses show that cuts to Medicaid in the Senate’s bill could result in a loss of billions of dollars in federal funding that could trigger the end of Medicaid expansion.
For one, the bill would require states to impose new work requirements and more frequent eligibility checks of people on the Medicaid rolls. Implementing the staff and systems necessary to do that would cost the state millions of dollars, health officials say. But the bill would also target provider taxes, a key funding source that states use to fund their share of Medicaid. The bill would gradually lower the cap on provider taxes from 6% to 3.5%, which would result in a significant reduction in federal funds.
In a post on X voicing his support for the bill, Berger said “the legislature will work through any implementation issues” that may arise.
Let’s be realistic. In order to save Medicaid expansion, lawmakers would have to do more than just remove the trigger that automatically terminates the program. They would also have to allocate potentially billions in state funding to make up for what will be lost — a prospect that seems both financially and politically unlikely. Representatives for Berger did not respond when asked if the legislature intends to “work through” those issues in a way that would fully make up for lost federal funding.
U.S. Sen. Thom Tillis did extensive research before arriving at his decision, speaking with hospitals, legislative leaders and the governor. He concluded that the combination of increased administrative costs and a reduction in provider taxes could result in the termination of Medicaid expansion. In a floor speech Sunday explaining his opposition to the bill, Tillis said that he showed White House experts his findings, which concluded the best-case scenario was a $26 billion cut in federal support for Medicaid. The experts “admitted that we were right” but said North Carolina is just “going to have to make it work,” Tillis said.
But it’s unclear if North Carolina can, or will, make it work. It’s strange that Berger would support legislation that could undo an achievement he helped make possible in the first place. When he announced he would finally support Medicaid expansion, he said he did so in part because he was convinced Congress wouldn’t lower the federal government’s share of expenses. Is he not frustrated by the fact that Congress, with the support of the president, is now effectively doing just that? Is he not angry for the 665,000 people in his state who may now suffer thanks to that broken promise?
Perhaps that’s just politics. For the first time in more than two decades, Berger faces a serious primary threat, from an opponent who has been more vocally pro-Trump than Berger has. Early polls suggest it could be an uphill battle. Publicly supporting Trump’s signature bill may be the kind of political posturing Berger needs to protect his own career, but he should be clear about where he stands on Medicaid cuts and the future of Medicaid expansion. He also needs to address how he and lawmakers would “work through” those issues. North Carolinians deserve honesty and transparency — not more promises that lawmakers won’t be able to keep.
This story was originally published July 3, 2025 at 5:00 AM with the headline "After helping NC expand Medicaid, Phil Berger now supports the bill that could kill it | Opinion."
