News & Observer (Raleigh, NC) October 2, 2019
Oct.
2--RALEIGH -- These days, support for Medicaid expansion in North Carolina
varies from Republican to Republican.
Republicans
in the state House are working on a proposal to expand the federal coverage
program for the poor. Republicans in the Senate say they're not interested in
Medicaid expansion. Meanwhile, some Republicans in rural North Carolina feel
neglected as they await solutions.
"We
don't have the luxury of doing things based on some national political party's
stance on some issue," Dale Wiggins, chairman of the Graham County
commissioners, told Republican Senate leader Phil Berger in a recent letter.
Democratic
Gov. Roy Cooper vetoed the GOP's proposed state budget largely because he
wanted to negotiate Medicaid expansion. The Obama-era Affordable Care Act
allows for expansion, and 36 states, including some under Republican control,
have decided to go along. The proposition is dividing North Carolina
Republicans.
The
House compromise, House Bill 655 -- NC Health Care for Working Families -- includes
a work requirement and a premium of 2% of the person's income. Both are
additions to Medicaid expansion that Democrats do not want. And some
Republicans don't want any kind of Medicaid expansion at all.
Berger
said Tuesday that the work requirements are just "window dressing"
and had been shot down by the courts in other states.
The
House hasn't so far approved the GOP compromise. Rep. Donny Lambeth, a Forsyth
County Republican, told reporters when the bill was in committee a few weeks
ago that he wanted to work out questions raised before getting it ready for a
floor vote.
Republicans
say expansion adds to the federal deficit and raises the possibility that the
federal government won't always pay the bulk of the costs as it does now.
Lambeth
said he's talked about the issue to civic groups and others, trying to explain
it, and that some conservatives have told him they don't like it because they
think it's Medicaid expansion. When he tells them about the work requirement,
that there's no state funding and that it includes preventative care they are
more supportive.
Lambeth
is sticking to the work requirement, which can also be volunteer work, and the
premiums.
Berger
stopped short of saying Senate Republicans would automatically reject the bill.
"We'll
have to look and see what comes over" [from the House] and then discuss it
among Republicans, he said.
Berger
said, however, that they are looking at ways to cover the working poor who are
not eligible for Medicaid and can't afford private insurance. He said Senate
Republicans do not think Medicaid expansion is the answer to that, citing
fiscal uncertainties with future budgets.
"Make
no mistake, the House bill is Medicaid expansion," Berger said. "I do
not support it."
In a
September health committee meeting, Rep. Becky Carney, a Mecklenburg County
Democrat, said the work requirement would add bureaucratic red tape and
administrative costs.
On
Tuesday, Democratic lawmakers held a hearing on Medicaid expansion at the
Legislative Building.
Waiting
for solutions
Amid
the standoff, Berger exchanged letters with commissioners in Graham County,
located west of Asheville.
The
board, which has four Republicans and a Democrat, released a statement on Aug.
26 supporting House Bill 655 and saying commissioners "understand that the
majority of uninsured individuals in North Carolina are employed but do not
make enough money to afford health insurance coverage."
On
Sept. 10, Berger sent a letter to Graham commissioners hoping to clarify the
situation. He suggested commissioners had been misled by a letter from Cooper
"that doesn't provide all of the facts."
Berger
encouraged the board to "contact Governor Cooper and tell him to drop his
single-issue ultimatum and support the budget passed by the General Assembly."
The
board apparently didn't appreciate Berger's letter. Wiggins, the board's
chairman, responded to Berger in a Sept. 16 letter.
"Here
in Graham County Senator, we are accustomed to being ignored by not only the
governor but by our legislature as well," Wiggins wrote.
"We
supported Medicaid expansion because our citizens need it. Did you know Senator
that our poverty level is near 30%?" he continued. "Did you know that
we have several hundred working adults with no means to have health care?"
The
decline of manufacturing left Graham County without a large private employer,
Wiggins said. Given the dire circumstances, he said commissioners have to
consider solutions that aren't necessarily Republican ideas.
"While
some politicians like to operate as 'one size fits all,' that approach doesn't
fit rural NC," he told Berger.
"The
reality is in places like Graham County," Wiggins said, "a mom or dad
working at McDonald's or Wendy's for just over minimum wage cannot afford
$1,500 a month for insurance."
Wiggins
concluded his letter by suggesting legislators don't understand his county's
hardship.
"You
know Senator Berger," he said. "for some people who have good paying
jobs and good health insurance it is easy to say that those without health
insurance just need to go to work, isn't it?"
Asked
for comment on Wiggins' letter Tuesday, Berger spokesman Pat Ryan said the
Senate leader appreciated the commissioner's feedback.
"While
Senator Berger disagrees that Medicaid expansion is good policy, the health
care access issues raised by the Graham County Commissioners are real,"
Ryan said. He again called on Cooper to drop "his Medicaid-or-nothing
ultimatum" and to negotiate health policy apart from the budget.
For
more North Carolina government and politics news, listen to the Domecast
politics podcast from The News & Observer and the NC Insider. You can find
it on Megaphone, Apple Podcasts, iHeartRadio, Stitcher or wherever you get your
podcasts.
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