But this week Tillis struck a different note.

“It wasn’t like I had an ideological objection to expanding Medicaid,” he told Time Warner Cable News. “We’re trending in a direction where we should consider potential expansion. … I would encourage the state legislature and the governor to consider it.”

Democrats were quick to cry flip-flop.

“Tillis has done a complete 180,” MSNBC’s Ed Schultz said this week. “Talk about a change of heart.”

The change comes as state leaders across the country who once rejected the idea – along with the federal dollars that came with it – face increasing pressure to reverse course and expand the program that provides medical care to the poor.

Last month, Public Policy Polling, a Democratic-leaning firm in Raleigh, found that 57 percent of likely N.C. voters support expansion while 28 percent oppose it.

The debate also returns health care to the headlines in the nation’s most expensive U.S. Senate race. It was over a year ago that outside groups first ran ads criticizing Democratic Sen. Kay Hagan over her support of the Affordable Care Act.

Tillis’ campaign says his position, like that of Gov. Pat McCrory, has evolved as administration officials say management problems have improved at the state Department of Health and Human Services.

As House speaker, Tillis cited problems at DHSS and doubts about the cost in pushing to reject Medicaid expansion. Under the ACA, the federal government would have covered the cost of expanding the program to 500,000 North Carolinians for three years and paid 90 percent after that.

Now, hospitals are forced to treat many uninsured patients for free, which in turn raises prices for paying patients.

“Based on the previous state of the system, expansion would have eventually caused massive budget deficits, resulting in severe cuts to other important programs,” said Tillis spokesman Daniel Keylin. “(Now) the state’s Medicaid system is in a much better position.”

But pressure has built on state leaders like Tillis.

A report published in August by the Robert Wood Johnson Foundation and the Urban Institute said North Carolina stood to lose $39.6 billion in Medicaid funding over the next decade while N.C. hospitals would lose $11.3 billion in lost reimbursements. In September, PricewaterhouseCoopers’ Health Research Institute said hospitals in states that did expand coverage saw a significant rise in the number of paying customers and drop in the level of uncompensated care. By contrast, hospitals in North Carolina and the 23 other states that did not expand Medicaid saw “flat or sagging admission rates and little reduction in the number of uninsured, largely non-paying patients.” For hospitals, expansion means more reimbursed care. “We are pushing for expansion both in North and South Carolina,” said Martha Ann McConnell, a lobbyist with Carolinas HealthCare System. “Our message has been pretty consistent. We’re already paying for it both as citizens and as providers … and not realizing the benefit.”

In August, Gallup found that Arkansas and Kentucky led states in reducing their number of uninsured. Both states had expanded their Medicaid programs.

North Carolina DHHS Secretary Aldona Wos recently announced a $63 million budget surplus for the state’s Medicaid program. This month she told the Observer that along with some concessions by the government, that may open the door to eventual expansion.

Last October, McCrory rejected a request to call lawmakers into special session to deal with expansion. Tillis and Senate President Pro Tem Phil Berger issued a statement saying expansion would cost “hundreds of millions of dollars” over a decade.

“How do these Democratic Party front groups suggest we pay for it?” the GOP leaders said. “How many teachers are they willing to fire?”

Hagan spokeswoman Sadie Weiner said Tillis is “trying to have it both ways …”

Jonathan Oberlander, an associate professor of health policy administration at UNC Chapel Hill, said, “There’s no question it’s a flip-flop, and in my view one that’s long overdue.”

“No question it is really hurting North Carolina hospitals,” he said. “And there’s a growing realization how much it hurts the state not to expand.”

Link to original article from the Charlotte Observer: