Dalton's Governor-elect, Republican Pat McCrory, said as a candidate that he opposed Medicaid expansion. Dalton said his industry is leaning on McCrory and legislative leaders, though he commended "their deliberate approach." Similar efforts are underway in South Carolina, Georgia, Missouri and elsewhere.

For Democrats, Anzalone said the framing will be simpler: "You don't want to take a 9-to-1 match? That's a pretty easy investment. These governors who aren't expanding Medicaid, they're basically giving taxpayer money to the states that do."