GEOFF BENNETT: Since the Affordable Care Act was implemented more than a decade ago, 39 states have expanded Medicaid, the public insurance program that provides health coverage to low-income Americans.

North Carolina is not one of those states.

One of the obstacles had been Phil Berger, a Republican and president pro tem of the state Senate, but he changed his mind last year.

And now that the state legislature has reconvened, Medicaid expansion is a top priority.

North Carolina state Senator Phil Berger joins us now.

Thanks for being here.

And our team looked up a press release issued a decade ago this week in which you said of expanding Medicaid: "Saddling our citizens with the enormous costs of a new federal bureaucracy and entitlements is simply not the way."

What were your primary objections to expanding Medicaid at a time?

And, ultimately, why did you change your mind?

STATE SEN. PHIL BERGER (R-NC): So the big objection had to do with the impact on the state budget, or at least the potential impact on the state budget.

It was a new program.

The federal government said that they would be paying 90 percent of the cost.

Traditional Medicaid, the federal government pays about 66 percent of the cost.

That difference between 66 percent and 90 percent could bust our budget in significant ways.

And so there was a concern about whether or not the federal government would keep its word.

Since then, we have we have seen the federal government be controlled by Democrats, controlled by Republicans.

We have seen almost every iteration that you could have of control by one party or the other or joint control.

And they haven't changed that 90-10 split.

In my view, it's something that we ought to do.

And it makes perfect sense from a budgeting standpoint at this time.

GEOFF BENNETT: There was also an initial concern, as I understand it, that expanding Medicaid would have discouraged people from looking for work; is that right?

STATE SEN. PHIL BERGER: Well, we're looking at the potential of 600,000 people.

And, generally, the numbers that we were seeing was that the bulk of those folks would be able-bodied individuals who were not employed and not really looking for work.

The reality is that, with the way the federal program is designed, more often than not, what you have is a situation where folks who would be eligible for Medicaid in the expansion population are people that are actually working full time.

Sort of the person that seems to be helped the most would be a single female with one or two children who works a full-time job.

She's not eligible for traditional Medicaid, not eligible for subsidy of an exchange policy.

And so she just falls through a gap and does not have the funds to purchase private insurance.

So, I actually think that, at this time, a substantial number of the people that will be covered in the expansion population are people that are actually working.

Now, you have still got a good number of folks who will be able-bodied, not working, not willing to work who will be covered.

But I just think that, on balance, given the choices that we have, it turns out to be the best policy decision for us to make at this time.

GEOFF BENNETT: There are a few incentives these days for elected officials like yourself to change your mind on major issues like this.

Might there be any consequences?

What's your level of concern?

STATE SEN. PHIL BERGER: I think the public, by and large, is supportive of expansion of Medicaid.

I think the opposition is clearly there.

It's probably more pronounced in what would be described as a very red district, but, even there, the -- in the Senate last year, we had 44 votes in favor of expansion in the bill that we passed, only two votes opposed.

Most of those 44 positive votes were Republicans in Republican-leaning districts or strong Republican districts.

And, quite frankly, I don't remember expansion being an issue in either a primary or at this point in the general election in the way that would have been 10 years ago or that people would have thought would even be now.

GEOFF BENNETT: North Carolina State Senate Leader Phil Berger.

Senator Berger, thanks for your time.

STATE SEN. PHIL BERGER: Thank you.