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For several years now, Medicaid expansion has been proposed, debated, opposed and defeated, despite its promise to improve the lives of hundreds of thousands of North Carolinians.

The case has never been better and its supporters have never been stronger. This is the year state lawmakers should pass the measure. But it won’t be easy. Budget negotiations between the governor’s office and representatives of the state House and Senate began last week — and there’s a lot of agreement. Still, there’s probably no issue in Raleigh that is more contentious.

Gov. Roy Cooper, a Democrat, is expected to veto any budget that doesn’t include some form of Medicaid expansion, BH Media’s Richard Craver reported Sunday. And with the loss of Republican super-majorities in the House and Senate, a Cooper veto is likely to stick.

But Republicans, led by Senate President Pro Tem Phil Berger, have dug in their heels. In early negotiations, GOP legislative leaders offered to include in the budget a provision to convene a special session to address health access, which would include Medicaid expansion.

Why wait? The subject has been studied and dissected for nearly a decade now. Everybody in Raleigh, if not all of North Carolina, knows what it entails.

The expansion of Medicaid coverage was first proposed as a provision of the Affordable Care Act. Republicans wanted nothing to do with it. But in the ensuing years, support for Medicaid expansion has grown, even in red states, and for good reason: It’s practical. In North Carolina, it would create more than 37,000 new jobs and insure approximately 365,000 more people, according to a new analysis conducted by researchers at George Washington University with funding from Cone Health Foundation and the Kate B. Reynolds Charitable Trust. It also would increase business activity in the state by $11.7 billion between 2020 and 2022.

“Medicaid expansion is a job creator and can extend health coverage to thousands of previously uninsured North Carolinians who are falling through the gaps in our current system,” said Susan Shumaker, the president of Cone Health Foundation. “States that have already expanded Medicaid are better equipped to tackle critical health care concerns like opioid addiction and infant mortality rates, issues that need to be addressed here at home in North Carolina.”

Business leaders, as well as health experts, religious leaders and some Republican legislators support expanding Medicaid. But Berger has been steadfastly opposed. His reluctance, even to a GOP-created option with a work requirement for some participants, is baffling. The primary reason he has given — that the federal government might not do its part as promised — isn’t just unrealistic; it’s absurd.

His recalcitrance may be rooted in a simple distaste for a program advocated by President Obama. But his obstinance has gone too far. It’s costing us jobs, it’s costing us tax money that goes from North Carolina to other states, and it’s ultimately costing the health and even lives of North Carolinians who have committed no crime except to be poor.

All within Berger’s sphere of influence should be telling him to knock it off. Compromise. Make a deal. Expand Medicaid now.

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