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By Jared Weber and Rose Hoban

A few years ago, LaDonna May-Barnes noticed a weird patch of skin on her arm.

“Eventually, I began to suspect that the lesion was cancerous,” she said. “But I didn’t have health insurance.”

May-Barnes, a single parent, made too much to qualify for Medicaid, yet too little to purchase her own private insurance plan. As it was, she was struggling to house and feed her family.

“So, I did what so many in our circumstance did and still do; I went without the medical care I knew I probably needed,” she said.

LaDonna May-Barnes recounts the brush with skin cancer she had while she was uninsured. She said she waited to seek care because she knew she couldn’t pay. Photo credit: Rose Hoban

Eventually, May-Barnes became eligible for insurance through her graduate school program. Almost as soon as she got insurance, she was at the doctor, who confirmed her worst fear: cancer.

May-Barnes choked up as she told her story to several dozen people who came together to pray on Wednesday morning in Raleigh at a breakfast hosted by the coalition Care4Carolina.

Care4Carolina was founded in 2015 with the aim to close the state’s health insurance gap. The coalition’s director, Carla Obiol, said that, so far, about 35 organizations have worked together to achieve the goal.

They were joined by a handful of lawmakers all of whom were the sponsors of a bill that would provide a low-cost health insurance option for working people. The bill, Carolina Cares, would do that by using the option for expanding the state’s Medicaid program, something that was allowed for in the Affordable Care Act.

Making an end run

Anything with even a whiff of “Medicaid expansion” has been a tough sell at the legislature, where members of the Republican supermajority have firmly resisted the move since the beginning of the 2013 legislative session. That’s when they pushed through a bill requiring legislative approval to add some half million low-income people to the program who currently earn more than North Carolina’s current income cutoff of $5,948 for an individual ($12,299 for a family of four), and yet who make too little to afford subsidized health insurance that’s available through the ACA.

General Assembly lawmakers also effectively cut off potential moves by a governor to make the move unilaterally, something Roy Cooper learned once he was elected.

Alamance County farmer Alex Hitt speaks at the 2017 press conference that rolled out Carolina Cares, a bill that would expand Medicaid for many of the working poor. The bill would require beneficiaries to pay small premiums, participate in preventive care and perform 20 hours per week of work in order to be eligible. The bill currently is stuck in committee. Photo credit: Rose Hoban

When Cooper was sworn into the governor’s office on new year’s day 2017, he made a gambit to push the expansion in the waning days of the Obama administration. But his efforts were stymied by the legislature, which was able to successfully use the courts to restrict him from acting.

But years of advocacy have begun to soften some Republicans’ opposition to the move, in part because a coalition of advocates has been making the point that many people who fall into the “coverage gap” are low-income workers, such as Alex Hitt, a farmer from Alamance County.

Hitt said that many farmers, fishermen and other rural workers don’t make enough money to qualify for insurance premium subsidies, which kick in once an individual makes about $16,389 (or $33,885 for a family of four).

Hitt and his wife Betsy make about $30,000 a year, he said, which puts them in the top 17 percent of farm earners nationwide.

“Many farm families have someone who works in town… which also helps to make a farm viable moneywise, but also allows them to have coverage if the spouse has a job that’s not at McDonald’s, like a teacher,” Hitt said. “ The reduction on premiums has been a lifesaver for us because the premiums were becoming prohibitive on the open market.”

It was stories such as these that convinced Reps. Donny Lambeth (R-Winston-Salem), Josh Dobson (R-Nebo) and Greg Murphy (R-Greenville) to sign on as a primary sponsor for the Carolina Cares bill, which was introduced in April 2017. All three were at Wednesday’s event.

“It’s not expansion in its traditional sense,” Dobson said. “It’s a common sense solution to get more people covered here in North Carolina.”

Dobson said it’s still something of a lift to convince the other members of the legislature, but he said that if the bill were to be put to a vote in the House of Representatives, it would pass, with help from Democrats.

Praying for care

In his opening prayer, pastor Gene Tyson of the Fuquay Varina United Methodist Church prayed for state legislators to consider God’s way in how they handle the coverage gap.

“We know you to be a God of healing and love,” Tyson intoned. “You care for the rich and the poor; the old and the young; the sick and the well, and you desire that our lives be lived abundantly and with wholeness.”

Health care advocates pray with lawmakers during the breakfast Wednesday morning, held at the NC Museum of History in downtown Raleigh. Photo credit: Jared Weber

While other speakers didn’t quite pray, they took a ministerial tone, urging legislators to take action this session.

Nashville Police Chief Thomas Bashore, who started a local initiative to allow individuals with substance abuse to receive free treatment, said more than 90 percent of the people who have benefitted from his program lack health insurance.

Without Medicaid expansion, he said many of those recoveries could be at risk.

“If you don’t have adequate health care, you’re not going to be afforded the treatment options you need to ensure your long-term recovery,” Bashore said.

Farmers like Alex Hitt and April Tutor claim that, despite the dangers of their occupation, many agricultural workers have no financial option but to live uninsured.

Care4Carolina Director Carla Obiol said she has faith that the event raised awareness of citizens who live within the coverage gap. She hopes that legislators will consider Carolina Cares this session.

“Right now, it’s the best solution on the table and we really want to see it get a hearing in the General Assembly,” she said. “It’s important that this legislation be heard from our account.”

As he spoke to the group, Murphy reminded the people gathered of the corporal works of mercy, such as feeding the hungry and healing the sick.

“And we also now have to extrapolate that we have to care for our fellow man and woman as far as taking care of their health care needs,” he said.

“We have … a responsibility as legislators to take care of those in need in our state,” he continued. “These individuals want help ups, not hand outs. They are proud individuals and want to work but just need to be able to have help with that gap.”

Correction: LaDonna May-Barnes name was originally spelled LeDonna.

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Jared Weber

Jared Weber is NC Health News' 2018 legislative intern. He is a rising junior at UNC Chapel Hill where he's majoring in journalism and global studies with a minor in Spanish.