Ten years ago, Republicans in the North Carolina state House were lining up to vote against Medicaid expansion for their state. They had an opportunity to open up the program to anybody with income below or just above the poverty line, with the federal government picking up most of the cost through the Affordable Care Act. They passed it up, arguing that the existing Medicaid program was too expensive and too broken. They warned that the federal government might reduce its contributions in the future, and that offering more people Medicaid would give them less incentive to work.