Tim Moore Healthcare North Carolina

Tim Moore Blocked Medicaid Expansion for a Decade, Then Called It Something "We Can All Be Very Proud Of" — and Voted to Blow It Up

Twelve North Carolina rural hospitals closed or dropped inpatient care while Tim Moore's House refused to expand Medicaid. He finally relented in 2023, took a victory lap, and then voted for a federal bill that could end the whole program.

MAGA Report Cards · Aug 09, 2026

Tim Moore Blocked Medicaid Expansion for a Decade, Then Called It Something "We Can All Be Very Proud Of" — and Voted to Blow It Up

There is a specific kind of political career that only works if nobody keeps notes. Tim Moore's record on health care is the case study.

Moore spent ten years as Speaker of the North Carolina House. For most of that time, his chamber was the wall that Medicaid expansion could not get past. North Carolina Republicans resisted expansion for more than a decade before finally agreeing to it in 2023.

While they held out, twelve rural hospitals in North Carolina shut down or stopped providing inpatient care between 2005 and 2023, according to the Cecil G. Sheps Center for Health Services Research at UNC Chapel Hill.

What He Said While People Were Uninsured

In November 2021, WFAE asked Moore to explain why his House wouldn't move on expansion. He was candid about it. He described a "philosophical opposition to just the blanket Medicaid expansion," and laid out the reasoning:

"I believe that any kind of benefit program should really be for those who cannot take care of themselves. If someone is able-bodied, we ought to do all we can as a state to incentivize a person to get a job."

Set aside the philosophy for a second and look at who he was describing. The people who gained coverage when North Carolina finally expanded were overwhelmingly working adults who earned too much for old Medicaid and too little to buy insurance — the exact group Moore called "the working poor" in that same interview and said he was "all for looking at things to try to help."

He had the gavel. He could have helped them any day for ten years. He didn't.

Then He Took the Victory Lap

On March 2, 2023, Moore stood next to Senate leader Phil Berger and announced a deal. His comment on the expansion he had blocked for a decade:

"This is something that we can all be very proud of… What a huge announcement this is for North Carolina. What a huge policy direction this is that will provide help for so many in this state, but it's going to do it in a way that's fiscally responsible."

Nearly 680,000 North Carolinians have gained coverage since the program launched, more than a third of them in rural counties.

Every one of those people could have had coverage years earlier. The bill that finally passed wasn't dramatically different from what was available the whole time. What changed was the politics, not the policy — and Moore's response to that was to describe the thing he'd stopped as an achievement.

And Then He Went to Washington and Voted to End It

Moore was elected to Congress in 2024. In 2025, he voted for Trump's budget bill.

Here is why that matters more in North Carolina than almost anywhere else. When state Republicans finally passed expansion, they wrote in an escape hatch: if the federal government's share of the cost ever drops below 90%, North Carolina's expansion ends automatically. No new vote. No debate. The coverage just stops.

Trump's budget bill cuts federal Medicaid spending. That puts a program covering 680,000 of Moore's own constituents' neighbors within reach of a trigger he helped write into state law.

The bill included a $50 billion fund for rural hospitals to soften the blow. North Carolina's share works out to roughly $100 million a year — against the roughly $3.7 billion the state's rural hospitals stand to lose.

UNC researchers found that 338 rural hospitals nationwide were at risk of closing under the bill's Medicaid and Medicare cuts. Five of them are in North Carolina, including Person Memorial in Roxboro and UNC Health Chatham in Siler City.

North Carolina's other Republican in the Senate, Thom Tillis, voted against the bill and said so on the Senate floor, asking what happens to hundreds of thousands of North Carolinians if the federal money disappears. Moore voted yes.

What It Looks Like From a Doctor's Office

Dr. Laura Ucik, a family physician in Henderson, described what losing coverage means for her younger patients with serious chronic illness:

"If they lose Medicaid… life is over. Like, it's just over. They're not going to make it to 30."

That is the stake. Not a budget line. Not a philosophical position about able-bodied adults. Whether a diabetic 24-year-old in rural North Carolina reaches 30.

He Won't Face the People Affected

Constituents have tried to reach him about this. In 2025, protesters carried a black casket to his Gastonia office over the Medicaid cuts. They have held town halls in his absence — two of them — after failing to get a meeting.

This is a man who has never let the people on the other end of his votes get close enough to ask him a question. He blocked their coverage for ten years and explained it as a work-ethic problem. He took credit the day it finally passed. Then he cast a vote in Washington that could switch it off automatically.

Consistency was never the point. Being on the winning side of whatever room he's standing in has always been the point — the same instinct that shows up in his personal business dealings and his stock portfolio.

We deserve better.