Healthcare promises to be a central topic of discussion in the 2020 presidential race, as the contenders for the Democratic nomination begin lining up their policies.
In Chatham County, several of its leaders have firmly planted their flag in favor of Medicaid expansion.
Chatham’s state legislators have co-sponsored bills at the state level to expand the government-run healthcare program, and the Chatham County Board of Commissioners passed a resolution in favor of expansion at its April 15 meeting. But this support, according to one of those legislators, doesn’t necessarily mean it will work out in their favor in Raleigh.
Medicaid was signed into law in 1965 as a health insurance system for low-income individuals and people with disabilities, among other groups. According to the Centers for Medicare & Medicaid services, the program covered 65.9 million people in 2018, just more than one-fifth of the U.S.’s population, making it the largest source of healthcare coverage in the country.
Originally, eligible groups included pregnant women, infants and children aged 1-18 at or below the poverty level, disabled adult children and more. When the Affordable Care Act passed in 2010, eligibility was extended to children who lived at 133 percent of the federal poverty level in each state, and states were given the option to extend that threshold to adults.
Several states have extended that coverage, but North Carolina is not one of them. In fact, the General Assembly passed a law in 2013 that officially “reject(ed) the Affordable Care Act’s Optional Medicaid Expansion.” The bill stated that no entity “shall attempt to expand Medicaid eligibility standards...unless directed to do so by the General Assembly.”
That hasn’t stopped a group of legislators this session, all Democrats, from proposing House Bill 5 — and its twin in the Senate, Senate Bill 3 — to “close the Medicaid coverage gap.” Rep. Robert Reives II (D-Chatham), is one of the bill’s co-sponsors.
“I’m just not a firm believer that healthcare is something we can leave people to their own devices,” Reives told the News + Record. “For me, the easiest thing to do is clean Medicaid expansion.”
The bill would extend coverage eligibility for adults aged 19-65 whose gross income is at or below 133 percent of the poverty level. It would also repeal the 2013 law. But Reives is not confident of that bill even getting to the House floor.
“I don’t believe we’re on a path right now that would get us a vote, unfortunately,” he said.
One particular barrier to the Democrats’ plan that Reives discussed is a similar healthcare bill proposed by Republicans. House Bill 655, titled “NC Health Care for Working Families,” declares the intent of the General Assembly to “facilitate the design of a health care program that addresses the needs of citizens of North Carolina committed to a healthy lifestyle who are ineligible for Medicaid due to their income levels but who are otherwise unable to afford health insurance.”
Once the program is established, residents who are deemed eligible must meet “all federal Medicaid citizenship and immigration requirements” and the same stipulations laid out in the Democratic plan. However, participants would be required to work, participate in “preventive care and wellness activities,” pay a premium of 2 percent of household income and make co-payments.
Reives said that, as of now, he’s not “necessarily comfortable” with HB655 as written, but “might support some version...at some point.” He particularly cited the work requirement as “ironic,” considering the program’s design for low-income families. Last month, a federal judge blocked Kentucky from implementing the requirement and ceased Arkansas’ mandatory employment stipulation.
Meanwhile, the Chatham County Board of Commissioners, in a unanimous vote, came out clearly on one side of the issue.
On April 15, the board passed a resolution in favor of expanding Medicaid. The resolution stated that more than 1,800 people in Chatham County and 500,000 people in North Carolina would qualify for services if expanded. Commissioner Jim Crawford, who brought forth the resolution and is the board’s liaison to the Chatham County Board of Health, emphasized that expanding the program would bring money North Carolina taxpayers are already paying into the program back to the state and not to other states.
“So I think it makes moral sense to help those who are most vulnerable,” Crawford said, “and it makes economic sense to use the money that we’re paying into the system to the benefit of our own people.”
The resolution was supported by all the board, including Republican Walter Petty, who initially expressed his reservations about the resolution, citing concerns about Medicaid as a program.
“I feel like there are better ways to get the problem addressed,” he said. “I don’t know that they’ve been discovered yet. Because we don’t have a better way right now, I will support the resolution right now.”
Commissioner Karen Howard acknowledged Petty’s concern that “Medicaid is not perfect,” but added, “I think we can’t let people fall in the gap in the interim while we figure out a perfect plan and pay into it.”
So while Chatham’s leaders — state Sen. Valerie Foushee co-sponsored the state Senate’s version of HB5 — are firmly on the side of expansion, Reives isn’t sure that’s going to happen.
“We’ve got a long way to go,” he said. “(But) to me, it’s a no-brainer that we should be doing it.”
Reives
Reives