(WGHP) — For years, Democrats from President Obama on down called for expansion of the federal Medicaid program, and states resisted it. In North Carolina, Republicans in the General Assembly were the prime opponents, saying that the state version of it was hemorrhaging money and needed to be fixed before hundreds of thousands more people were put into it.

“I’ve been an opponent (of expansion),” said Forsyth County State Senator Joyce Krawiec. “Medicaid was broken in North Carolina. When I first got to the senate, we were filling $2 billion holes (in the state Medicaid budget) because it was broken. It was overspent every year. We’ve taken care of all that. We fixed the problem. We’ve had eight straight years where we have been under budget on Medicaid, so we think now’s the time (to expand). And the federal government keeps adding sweeteners…originally when we were talking about it, it was going to cost about $3 billion dollars a year, and that was a real concern for me as a budget-maker. And that’s not the case anymore. Now, it will be a revenue enhancer in North Carolina, and I think it’s a lifeline for our rural hospitals.”

Krawiec has turned her thinking around on the subject to the degree that she and State Senate President Phil Berger are leading the writing of the new law to expand Medicaid in North Carolina.

“It’s the right thing to do, and I think it’s the right time to do it,” Krawiec said. “It will provide care for those who are working, who are trying hard every day to make ends meet, and they have to put food on the table, pay their rent, and there’s nothing left to buy insurance.”

Not everyone agrees. Jordan Roberts is a healthcare analyst at the Raleigh think tank The John Locke Foundation. Among his concerns is whether we have the healthcare infrastructure to handle the new patients.

“Right now, we have 2.7 million people on Medicaid,” Roberts said. “All the estimates show that it would be upward of 600,000 people being added to the rolls if we did expand Medicaid, and that could be over 3,000,000 people on Medicaid – one out of every three in our state – and we believe that as the program will continue to grow, facing recessions, we know that more people would get on Medicaid, too. We think it puts the program in jeopardy and increases state liability for this open-ended entitlement.”

But Cody Hand, who is a spokesperson for the North Carolina Healthcare Association says expanding will cut costs for everyone in the long run.

“We see patients when it’s often too late. Expansion would mean those patients could get primary care,” Hand said.

Before Medicaid is expanded, Roberts says free-market advocates think there are other things that should be tried, first.

“We would argue that there are a lot of reforms that we can do in the private markets coming from Congress as well,” Roberts said. “We think a lot of the problems started with the Affordable Care Act taking state control away from insurance markets. I would argue…that there are a lot of plans like direct primary care that you could get. That’s a monthly membership fee to a primary care office, so there are these other models that we can look at that aren’t reliant on insurance. What we argue a lot…is that just because you have an insurance card, doesn’t mean you get the care you need. So when we face supply shortages around the state, problems with wait times in doctor’s offices, insurance only takes you so far.”

The biggest hurdle to expanding Medicaid is that some in the State House of Representatives aren’t sold on the idea to the point where the House can pass a bill on it in this year’s short session.

“To think that we can just suddenly resolve that in weeks, that’s really tough because there are so many moving pieces…it’s not just a matter of…either expand or don’t expand, but…it goes much deeper than that. It’s a much more complex issue. And the Senate, of course, has put in there some other items that have also been in controversy for quite a while, so I think it would be a press to get that resolved this session,” said House Speaker Tim Moore, of Cleveland County.

Plus, he’s not confident all the payments coming from the federal government, which pays for 90% of the program for most states, will last.

“If I do the math, and it’s a true 90/10 match, and the reimbursement rates are maintained, all those things are kept the same…you can make those numbers work,” Moore said. “But, if the feds…change that formula or something happens on either covered services or reimbursement rates, you could have a significant issue thrown on the state that would cost a lot of money that’s not being factored in.”

See more about the Medicaid expansion debate in this edition of the Buckley Report.