The proposal from four Republican legislators to extend government health insurance coverage to poor adults will have a hard time getting through the legislature.

House Speaker Tim Moore said Monday that he remains opposed to Medicaid expansion.

“The best thing to do for the working poor is to continue to grow the economy,” Moore said.

Thirty-one states and the District of Columbia have expanded Medicaid, though many Republican-run states have not.

Some Republican states that have expanded Medicaid came up with their own plans and got them approved by the federal government. Republican states that wrote their own plans commonly require adults who gain insurance coverage to share the cost by paying premiums and co-pays. The four Republican legislators’ proposal takes a similar approach.

Under the North Carolina bill, which sponsors plan to discuss Tuesday morning, adults whose incomes are at or below 133 percent of the federal poverty level – less than $16,000 for a single person – would qualify. They would have to pay annual premiums equal to 2 percent of their household income, with some hardship exemptions. In most cases, adults would have to be working or “engaged in activities that promote employment” to be eligible for the coverage.

The bill was the first formal indication that Republican members were considering ways to expand Medicaid.

Rep. Greg Murphy, a medical doctor and one of the bill’s sponsors, said the bill would be a “win-win” for the state.

Beneficiaries would have “skin in the game” through their premiums, he said, and more working poor people would have health coverage at no cost to the state.

The state and federal governments pay the costs of Medicaid, with the federal government picking up most of expense. The bill proposes that state hospitals would pay the state’s share of the cost for the adults who would be added through expansion.

“There’s no cost to the state and every benefit for the state,” Murphy said.

Other Republican-run states wanted to make beneficiaries work in order to qualify for insurance. The Obama administration rejected those requests, but the Trump administration will be more receptive.

In a letter to governors, U.S. Health and Human Services Secretary Tim Price, and Seema Verma. who runs the federal Medicaid office, indicated they would be open to work requirements for Medicaid beneficiaries and proposals to have beneficiaries pay premiums or co-pays.

Rep. Nelson Dollar, the chief budget writer in the House and a Cary Republican said the bill “is the start of a conversation.”

Rep. Donny Lambeth, a Winston-Salem Republican and one of the bill’s sponsors “worked on ways in which North Carolina can have a potentially unique approach to ensuring we have coverage for people in North Carolina,” Dollar said.

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NC Medicaid expansion will have a rough ride in the legislature