NC Republicans Have Lost on Medicaid Expansion. They Just Don’t Know It Yet.

NC Senate leader Phil Berger in a 2016 file photo. A NC teacher says Berger and House Speaker Tim Moore have overseen a punishing decade for public education. She's calling on North Carolinians to vote as if their schools are at stake. (AP Photo/Gerry Broome)

By Billy Ball

September 17, 2020

A decade after rejecting Medicaid expansion’s boost in health care for low-income people, the GOP remains opposed, even if most in NC are not.

It could have happened to any of us, but it happened to Montica Talmadge

Talmadge was training for a Raleigh marathon when a driver smashed into the rear of her stopped car. The 27-year-old from Raleigh required oxygen to survive when she developed dozens of potentially deadly blood clots in her lungs. 

And when she lost her job—followed, naturally, by her health insurance—a few months after the accident, the cost of her medicine skyrocketed from $30 monthly to $840. 

Talmadge applied for and received health insurance through the Affordable Care Act. She’s just one example of a North Carolinian who benefited from government-backed programs like the ACA or its expansion of Medicaid, a government-run health insurance program for low-income people that would be available to about 500,000 people in North Carolina if lawmakers would allow it. 

Talmadge, who made the case this year for the ACA during a call with reporters, is not a pawn of any advocacy group or the Democratic Party, which has, smartly, centered Medicaid expansion in many of their state legislative races this year. 

And Talmadge’s story, unfortunate as it is, is hardly even an outlier. The coronavirus pandemic has made health care, which most Americans view as a fundamental responsibility of government, more of an economic privilege in this state than it has ever been.

A report this summer found that the pandemic has left a record number of North Carolinians, about 20% of adults, without health insurance. 

Surely, many would benefit from the ACA’s Medicaid expansion, which is mostly paid for by the federal government. So too would our economy, and our rural hospitals, such precariously-financed hubs of commerce for North Carolina communities. 

“The issue of Medicaid expansion needs to be dealt with quickly,” Chris Lumsden, CEO of Northern Hospital in Surry County, told Gov. Roy Cooper last year, NC Health News reported.

By this point, most North Carolinians already know this to be true. A recent poll found that three-quarters of North Carolinians support expansion. Support crossed party lines, which makes sense. Political affiliation is about as useless in a hospital waiting room as an umbrella in a windstorm.

Republican leadership from President Trump down to the state houses has sought to undermine the ACA and Medicaid expansion time and again. 

But they have lost this debate, whether they know it or not. 

Their promises of massive state budgets and swamped doctor’s offices have not materialized in the 38 states that have already expanded the program, many of them, like NC, Republican-run states.

“Now, when you die and get to the meeting with St. Peter, he’s probably not going to ask you much about what you did about keeping government small,” former Ohio governor and GOP presidential candidate John Kasich said in 2013 as his state moved for Medicaid expansion. “But he is going to ask you what you did for the poor. You better have a good answer.”

‘Empathy, not epithets.’

Yes, the ACA, a government-sponsored program is not reflective of “small government” Republican ideals. Yes, some people fear that the ACA’s expansions would overwhelm state budgets. Still others fear  the federal government would renege on its commitment to pay the lion’s share of those costs. Conservative ideology on this matter is, at its core, not illogical. 

But these fears have not come to fruition in other states, and are not likely to in North Carolina. In many states, expansion has offset costs or generated enough revenue to produce a net savings. And the possibility of a deadbeat federal government dropping its Medicaid commitment, something it hasn’t done in the program’s 50-year history, seems remote too, leaving primarily philosophical objections to Medicaid. 

But life is not a poorly-staged Ayn Rand novel. The people of North Carolina are not its ideological constructs. They breathe and they bleed. We need empathy, not epithets. Those leaders who make people and their practical issues subservient to philosophy are doomed to be judged as poor, if not negligent, leaders. A good leader supports an idea if it’s good for their constituents, even if others came up with it.

Yet when we’ve asked the state’s most influential healthcare lawmakers—people like state Senate President Phil Berger, an Eden Republican, and state Senate health care leader Joyce Krawiec, a Republican representing Forsyth and Davie counties—what they plan to do, we get bristling statements. The whole line of questioning is “fake news,” one suggested. 

That it slights the news media is irrelevant. The greater slight is to the people of North Carolina without the time or social media followers or connections to speak with senators, who aren’t interested in any public hearings on the matter, who cannot hear behind those apparently soundproof brass doors to the legislative chambers.

The hundreds of thousands of North Carolinians denied health insurance by the Medicaid blockade are not fake. Montica Talmadge is not fake. Those blood clots were not fake. Neither were her prescription medicines or her hospital bills surpassing $85,000. If Talmadge had spent that money instead on a top-flight lobbyist, would Republican state lawmakers hear her then? 

There is no hashtag that sums up the struggle of countless North Carolinians without health insurance; there is no budget report that can fathom their pain.

The coronavirus pandemic, and its demolition of the North Carolina economy, are not the fault of the legislature’s GOP leadership. But what legislators do, or rather what they choose not to do, during this critical moment in history most certainly is. 

Legislators and their sharpest critics have approached the issue of Medicaid expansion in the middle of a pandemic like a siege, as if one side could simply outlast the other. But the problem is legislators have not yet felt the pain. It is easy to stand firm when it is not you or yours sacrificing. As I wrote last year, GOP lawmakers in North Carolina have, for most of a decade now, chosen this hill for other people to die on.

But the voters of North Carolina go to the polls this year with ostensibly the fairest districts we’ve had in decades, which means the Medicaid poll numbers might actually mean something.

North Carolina lawmakers who continue to block Medicaid expansion should know that they do so in defiance of the vast majority of North Carolinians. And this year, they do so at their own electoral peril. 

Now they have something to lose too.


  • Billy Ball

    Billy Ball is Cardinal & Pine's senior community editor. He’s covered local, state and national politics, government, education, criminal justice, the environment and immigration in North Carolina for almost two decades, winning state, regional and national awards for his reporting and commentary.

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