States that have rejected Medicaid expansion look a lot like the Confederacy. This is a recurring theme, isn’t it? That — what do we call it? — stubborn reluctance to actually join the rest of the red, white, and blue country Southerners loudly and proudly celebrate alongside their battle-flag-waving “heritage” of insurrection means many would rather harm themselves than accede to rejoining the Union not just in fact but in spirit.
For those Hullabaloo readers in one of those orange states shown above, the following approach to flanking Republican objections to expanding Medicaid might hold promise.
Casey Cooper is the CEO of the Cherokee Indian Hospital in Cherokee, North Carolina, home to the Eastern Band of Cherokee Indians in the western tip of the state. Cooper has been making presentations advocating Medicaid expansion to Republican-dominated county commissions in Rep. Madison Cawthorn’s NC-11.
“In the interest of efficiency, I will just jump right to the punchline,” Cooper told Macon County’s board of commissioners (pop. 37,000) in August. “It’s my hope that at the conclusion of this presentation tonight that you will feel compelled to support a resolution to help close the coverage gap in North Carolina.” Meaning a resolution supporting Medicaid expansion.
Cooper’s strategy is to get county governments on board as a means of pressuring lawmakers in the state capitol. Commissioners in Swain and Jackson counties had both unanimously passed his resolution. Their commissioners might be majority Democratic, but their counties voted for Trump in 2020. This is not unusual. Voters select Democrats to run things locally but Republicans in federal elections.
Brian McMahan, the chairman of Jackson County’s Board of Commissioners, explained that he was in favor of Medicaid expansion before Cooper came to speak with the board, but he described the presentation as “thorough” and “compelling.” He said it strengthened his resolve.
“We literally have people who are dying because they don’t have access to health care,” said Brian McMahan, chairman of Jackson County’s Board of Commissioners. “And if that’s not enough reason, the fact [is] that it’s a job creator.”
NC Health News explains:
Back in 2019, Dale Wiggins, the Republican then-chairman of Graham County’s Board of Commissioners, publicly clashed with Senate leader Republican Phil Berger (Eden) over Medicaid expansion. Graham County’s board passed a unanimous resolution supporting a bill, co-sponsored by then-Rep. Kevin Corbin (R-Franklin), which would have expanded Medicaid coverage.
“What we have learned is if you cut out all the political rhetoric and just get down to the real facts of this issue, which then that puts it on a human being level, it’s not about Republicans. It’s not about Democrats,” Wiggins said in a recent conversation. “It’s about my neighbors, your neighbors, [who] are human beings. And in 2021, people need health care.”
Working through Gov. Roy Cooper’s (D) bipartisan North Carolina Council on Health Care Coverage, the pair set out to work on building support for the state expanding Medicaid under the Affordable Care Act. North Carolina is one of 12 states that have refused the opt-in.
In order to qualify for Medicaid coverage in North Carolina today, Casey Cooper explained in an interview, “If you are an adult, you have to be below 42 percent of the federal poverty level to qualify, and, I mean, that’s horrible. That’s like $7,000 or $7,300 a year.”
“If you’re a mama with two babies — and it’s not uncommon, right, to be a single mom with two babies — you don’t qualify for Marketplace subsidies until you get to $21,000 a year,” Cooper said. “If you make between $9,000 and $21,000 a year, you can’t get coverage.”
People who work full-time minimum wage jobs in North Carolina fall squarely into this gap. State minimum wage is $7.25 an hour, meaning someone working 40-hours a week would bring home $14,500 before taxes.
Expansion would open up eligibility to workers – with and without children – earning below 138 percent of the federal poverty level ($23,791 for a family of two).
Closing the gap in coverage, Cooper told Macon commissioners, “could lead to providing coverage for about 1,300 of your citizens, create about 62 jobs and about $169,000 in county revenues, and about $10 million a year in new business activity.” His data from Georgetown University, George Washington University, and the governor’s task force “has been shared pretty widely across the state and to my knowledge has not been contested or questioned by anybody.”
Six red WNC counties have passed Cooper’s resolution. But first he has to dispell a few myths:
“One of the misconceptions about closing the coverage gap is that the folks that are uninsured are too triflin’ to work, and it’s simply not true. The data clearly demonstrates that the majority of folks that are uncovered are working,” he told the Macon commissioners. “Unfortunately, they’re working and they’re working poor.”
Cooper points out that many of the uninsured in the western part of the state are white people, mothers and veterans.
“Most of the time, it’s mamas who are taking care of babies who still have Medicaid, they got their babies covered, they’re getting well child visits for the babies, but these mamas are going without coverage,” he said.
Not only that, but the health care funding pinch has meant the closing of smaller hospitals in rural America, including WNC. “Since 2010, over 120 rural hospitals have closed across the United States, including seven in North Carolina alone,” WRAL (Raleigh) reported in June.
But the Republican chair of Haywood County’s Board of Commissioners will not bring the resolution up for a vote. He doesn’t have the votes for passage. Despite expanded federal help that lowers the cost to the state even more, other commisssioners ask wonder who pays for it.
The Raleigh News and Observer reported in early October that Senate leader Berger indicated behind closed doors that he was open to negotiations involving expansion. However, in a statement last week, Berger’s office maintained the senator’s opinion has not changed, and that he believes Medicaid expansion is “bad policy.”
Bad for whom, exactly?
(h/t LS)