Growing number of conservative local leaders want Medicaid expanded in NC

Posted January 16, 2020 7:22 p.m. EST

— Medicaid expansion is a hyper-partisan political issue in the General Assembly, where it's the major sticking point in the continuing budget standoff between Democratic Gov. Roy Cooper and Republican legislative leaders.

But that's not the case across much of North Carolina, including a growing number of conservative counties.

A bipartisan group called Care4Carolina is gathering support for expansion, sometimes in the backyards of Republican lawmakers who oppose the idea.

"We believe we have a responsibility to look after our citizens. It’s a human being thing to us, not a political thing," said Graham County Commissioner Dale Wiggins.

Graham County, in the mountains of western North Carolina, is among the state's most conservative areas – about 80 percent of voters backed Donald Trump in the 2016 presidential election – yet the county commissioners unanimously support Medicaid expansion.

Wiggins and County Manager Becky Garland drove six hours to Raleigh on Wednesday to talk to lawmakers about the need for expansion. Garland said officials are worried they could lose their regional hospitals.

"As folks are having to avail themselves of the ER as their primary care, that is pushing the costs to these rural hospitals up, and they cannot sustain the costs of taking care of these folks," she said.

McDowell County is similarly conservative, but its chamber of commerce also supports Medicaid expansion.

"If you’re a working person and you’re paying your taxes and doing the right thing and you’re still being punished, so to speak, because you can’t afford health care, something's wrong with the system," chamber director Steve Bush said. "I challenge our leaders to do the right thing."

They and other Medicaid expansion proponents expressed frustration at the legislative inaction. Lawmakers didn't bother to address any health care proposals in their one-day session this week, and they aren't scheduled to return to Raleigh until the end of April.

A bill in the House to cover 300,000 low-income working adults through the Affordable Care Act has been idling since September, when a committee approved it overwhelmingly.

Senate President Pro Tem Phil Berger said on Tuesday that, even if that proposal makes it through the House, it doesn't have enough support to pass his chamber.

Erica Palmer Smith, director of Care4Carolina, said she believes that could change in the near future.

"It's hard for legislators to ignore the business support in their communities, the civic support in their communities, the health provider support in their communities," Smith said. "We are confident that, as we continue to build that support, it will become more difficult to ignore, and our leaders will step up."

"This is very vital to the citizens of Alamance County," said Sheriff Terry Johnson, another Republican, who notes that expansion could provide a way to address mental health problems that lead to crime and addiction in his community.

"Let’s deal with those issues, and we’re going to save money down the road – your incarceration, your courts, your crimes, murders, robberies, et cetera," Johnson said.

Kansas became the 37th state to expand Medicaid when the Democratic governor and the Republican state senate leader reached a deal this week. Most of the 13 that haven't are, like North Carolina, in the South.

Berger said Kansas' decision doesn't add pressure to accept expansion, which he considers the wrong path toward improving health care access.

“The only people that have asked me about Kansas have been members of the press,” Berger said.

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