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While mostly ceremonial there was already a partisan stir-up by the Republican majority in the House.

Cooper told The Associated Press in an interview Wednesday that he’ll need to rely partly on self-control by GOP leaders to prevent enactment of legislation he doesn't like. Cooper said he would keep fighting against additional abortion restrictions and for expanding Medicaid.

Expectations that a Medicaid expansion agreement in North Carolina are nigh have been short-circuited for now as Senate leader Phil Berger called an offer by the state's hospitals "not a serious proposal."

The legislation is being promoted by Speaker Tim Moore, who said it was a response to a wide-ranging health care access bill backed by GOP Senate leader Phil Berger that contains expansion and received overwhelming bipartisan support earlier this month.

House Bill 144 is part of the larger Medicaid transformation that has been taking place, technically independent from a proposal to expand Medicaid.

State Senators were busy in recent days as they approved several high-profile pieces of legislation. Meanwhile an environmental proposal filed in the House would punish corporations for dumping forever chemicals into watersheds. Yet it’s unclear if any of these bills will soon become law. Mitch Kokai from the John Locke Foundation and Rob Schofield with NC Policy Watch help review the week in state politics.

The Medicaid expansion bill includes significant changes to Certificate of Need (CON) regulations, which has already received strong pushback from the North Carolina Healthcare Association, a group that represents North Carolina hospitals.

The Medicaid expansion bill includes, word for word, the SAVE Act, a policy that nurses advocate for, but physicians oppose. If approved, it would loosen regulations on nurses that supporters say would increase access and reduce costs. However those in opposition to change say loosened regulations would reduce quality of care.

Support was nearly unanimous in the chamber for the measure, which also loosens practice restrictions on specialty nurses and eases government scrutiny of medical construction and equipment.

The Kaiser Family Foundation estimates nearly 400,000 people would be covered if North Carolina expands Medicaid under the Affordable Care Act.