(WGHP) — Since the passage of the Affordable Care Act years ago, some people in North Carolina have called for the state to enact what they see as a key provision: expanding Medicaid to cover more people.

Medicaid was designed in 1965 to cover people who weren’t healthy enough to work and children in families that didn’t have enough money to buy health insurance themselves and also didn’t have it provided to them through a parent or guardian’s job.

The General Assembly decided it was the right thing to do to make Medicaid available to those often referred to as “the working poor.”

“People that work a full-time job yet do not have healthcare provided by their employer, do not have enough money earned from their full-time employment to pay the premium for their healthcare,” North Carolina Senate President, Phil Berger said.

“600,000 North Carolinians now have access to coverage. And for them, it means they can have access to a primary care physician,” Cone Health CEO Dr. Mary Jo Cagle said.

Senator Berger says it will help everyone in the state.

“I think what happens is the fact that folks have that kind of coverage will hopefully avoid what we see now…someone has a nagging problem that can’t afford to go see a doctor. They end up letting that problem fester. They end up in an emergency room. They have a more serious problem. They don’t have insurance to cover the emergency room bill or other bills at the hospital,” he said. “Hopefully, what we’ll see is a healthier population and a healthier fiscal situation for some of our hospitals.”

The challenge is this: just passing a law doesn’t create the number of doctors, nurses and other healthcare professionals needed to administer the services.

“Absolutely, that’s a huge challenge, and we didn’t have a way to finance that because people didn’t have coverage,” Dr. Cagle said. “You know you can say ‘which comes first,? The chicken or the egg?’ But when people have coverage, then we have a way to begin to finance that both with primary care doctors but also with nurse practitioners.”

North Carolina’s Department of Health and Human Services has a somewhat different perspective, telling FOX8, via email, that, “Expansion gives more people access to routine care and preventive services, which are now often delivered in the emergency department. Routine care in a medical home helps treat people before they get sick, so they can get care in settings, other than the emergency department.”

But even before the expansion of Medicaid, the state was seeing a problem in having enough nurses, in particular.

“Nursing, in particular, is one of the issues…a large group of nurses left the field of nursing over the course of COVID. And many nurses have said, ‘I’m willing to work some, but I don’t want to work a full 40 hours a week…’not only did they leave during that rough last two years, some are still leaving,” Dr. Cagle said.

The state’s response to that was what’s called “The SAVE Act,” which would allow nurse practitioners, midwives and nurse anesthetists to do more of the work. It’s work they are trained to do.

“There is resistance in the house to most if not all of The Save Act,” Senator Berger said.

It is something Gov. Roy Cooper was supportive of last year.

For a while, there was some conjecture that expanding Medicaid might be an under-the-radar subsidy to businesses who might then drop healthcare coverage they currently supply to employees.

“I don’t think so,” Senator Berger said. “The bigger concern, for me…making sure that we have an adequate supply of healthcare for folks in the population so enough primary care providers, enough hospital facilities, enough diagnostic equipment, those sorts of things. I think those are bigger concerns.”

See more of the debate in this edition of The Buckley Report.