Raleigh, N.C. — Rep. David Lewis, R-Harnett, was the only Republican to vote against the bill banning the expansion of Medicaid Thursday. 

Lewis, who voted against the measure on second reading Wednesday, is no fan of the Affordable Care Act. He said he agrees, in principle, with much of what his GOP colleagues said about the bill and said expanding a troubled state Medicaid system would pose problems. 

Lewis described his third reading vote against the measure as  "a plea for help for rural health care." 

In a health committee hearing earlier this week, Lewis raised questions about the loss of "DISH" money, the bureaucratic slang for funding supplements that go to hospitals with a disproportionate share of patients who can't pay their bills and don't have insurance. 

The Affordable Care Act phases out DISH payments, but as part of a compromise on the federal level, proponents agreed to expand Medicaid so more patients would have health coverage. When the U.S. Supreme Court upheld the health care law last summer, however, it said states could not be forced to expand their Medicaid programs. 

Without extra Medicaid payments to make up for the loss of DISH payments, Lewis said, rural hospitals like the one in his district will suffer.

"I don't like the extortion that's being used to force states to take the Medicaid expansion," he said. "But I wanted to bring attention to the fact that, if that money goes away, many rural hospitals, including the one I represent, will go into the red." 

Nobody, he said, has been able to explain how the DISH money will be replaced. 

"It is significant," Lewis said, adding that hospitals could either be forced to close or slash many of the services they offer to help keep people healthy as a result of the loss of DISH money.