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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.

Then they said that voting for expansion was tantamount to voting for Obamacare , which was politically toxic among Republicans, and even some non-Republicans as well.

Wow, have things changed.

This week, Republicans in the North Carolina House lined up to vote on another expansion bill and this time most of them voted for it, with the legislation passing by a total margin of 87 to 24 . The vote came a week after the GOP-controlled Senate approved the same proposal by an even more lopsided, 44 to 2, margin.