Shows text supporting Medicaid expansion that reads: The Graham County Commissioners strongly give their full support to Representative Kevin Corbin for House Bill 655... The Graham County Board of Commissioners understand that the majority of uninsured inividuals in North Carolina are employed, but do not make enough money to afford health insurance coverage."
Screen shot of the resolution by Graham County Commissioners to support Rep. Kevin Corbin's (R-Franklin) vote for HB 655, the Health Care for Working Families Act.

By Rose Hoban

Dale Wiggins thinks it’s time. Actually, he thinks it’s past due.

Wiggins, a retired businessman, is the head of the Graham County Board of Commissioners, which recently sent a resolution of support for expanding the state’s Medicaid program to legislative leaders and Gov. Roy Cooper.

The unanimous resolution, signed by four Republicans and one Democrat, throws local support behind House Bill 655, which recently passed through the General Assembly’s House Health Committee and awaits a vote on the House floor.

The bill would use the Affordable Care Act to extend the Medicaid program to provide health insurance coverage to many low-income workers who currently don’t qualify for the program.

“We’ve got people here that literally can’t afford to be sick, they’re living from paycheck to paycheck,” Wiggins said in a recent phone conversation. “If a parent gets sick, loses a couple of weeks work, you know, they could potentially lose a car and lose a home. You know, so there’s a sense of urgency, at least in their lives.”

In a scathing letter (see attached below) sent to Senate leader Phil Berger (R-Eden), Wiggins explains why his board told their local representative Kevin Corbin (R-Franklin) to vote for the bill.

“You know Senator Berger for some people who have good paying jobs and good health insurance it is easy to say that those without insurance just need to go to work isn’t it?” he wrote. “The reality is in places like Graham County those people are working.”

When asked about Wiggins’ letter, Berger’s press aide Pat Ryan responded, “Everybody is entitled to express their opinions on matters before the state legislature, and Senator Berger appreciates the thoughtful feedback Mr. Wiggins provided in his letter. Feedback is always welcome.”

Upwelling of support

The feedback from commissioners, business leaders, economic development experts and other conservatives across the state is that they’re reaching a conclusion similar to Wiggins’. In the past few months, reliably conservative Republican boards and business leaders have been making it known publicly and privately that they think it’s time for North Carolina to follow in the footsteps of 34 other states and the District of Columbia and get low-income workers covered.

It’s a policy that’s long been opposed by the state GOP.

Usually, Medicaid is limited to low-income children, a small number of their parents, pregnant women and seniors in financial need. But the Affordable Care Act opened the door for states to add low-income workers who make too much to qualify for the program but too little to qualify for subsidies to purchase health insurance on the online marketplace.

In North Carolina, individuals making between about $6,120 and $16,860 have been caught in this “coverage gap,” even as lawmakers in other states have extended the benefit to their low-income workforce. The federal government has committed to paying 90 percent of the cost, more than the usual two-thirds of the cost for regular Medicaid patients.

After almost seven years, the data supporting the benefits of Medicaid expansion to states and individuals are becoming overwhelming. In August, the Kaiser Family Foundation published a review of 324 studies that show “improved access to care, utilization of services, the affordability of care, and financial security among the low-income population.”

Research also overwhelmingly shows that expanding Medicaid saves states money, even as it stimulates health care spending, producing a widening circle of economic benefits. For example, in states that have expanded, fewer rural hospitals closed than in states that didn’t.

Those are some of the reasons conservative stalwarts such as Alamance County Sheriff Terry Johnson and former GOP gubernatorial candidate George Little have come out in favor of expansion.

“You’ve got to do something for people,” Little said in an interview with NC Health News this summer. He believes the party as a whole is coming around, and he’s talking to his friends in the senate.

“It’s the economy, and seeing people … It’s the need,” he said.

Tourist economies

“We have one count that tells us that over 6,000 people in Carteret County are without health insurance,” said Tom Kies, president of the Carteret County Chamber of Commerce. “Our free clinic, Broad Street Clinic, puts the number at 1 in 4 people in Carteret County with no health insurance.”

Carteret County is known for its conservatism, along with the beach communities where people working in the tourism industry lack steady year-round income.

a woman gestures as she talks to a much taller man. They're talking about Medicaid expansion.
Former GOP gubernatorial candidate George Little speaks to NC Health News editor Rose Hoban after a business roundtable meeting in Pinehurst in August. Photo credit: Jill Hammergren Credit: Jason Gray / NC Rural Center

“People who are working two or three part-time jobs, just to pay the mortgage, working to pay the rent, they can’t afford health insurance,” Kies said. “And they make too much money for Medicaid.”

Because it’s such a conservative area, Kies said he was surprised to get a positive response to the idea of supporting expansion. The Chamber voted to send resolutions of support to House Rep. Pat McElraft (R-Emerald Isle) and Sen. Norman Sanderson (R-New Bern), he said.

Hurricane Florence really helped a lot of people change their tunes, Kies said.

“We saw that divide between the folks, between the haves and the have-nots in this county become much more pronounced,” he said. “We actually lost a lot of folks who were working those part-time jobs and the restaurants and the hotels and the rental companies.”

Now, the struggle is to keep the workers they have, he said.

“If we have these people who are working, we want to try to keep them healthy,” Kies said. “These workers are like gold right now.”

Understanding the importance

Carteret’s chamber isn’t alone in throwing their weight behind HB 655. NCEast Alliance Chambers, a group partnering with chambers in 13 eastern counties (including Carteret) has also endorsed the expansion of health insurance that would come with HB 655.

“They haven’t specifically said, expand Medicaid,” said John Chafee from the organization. “They said we wanted to expand the reach of health insurance for more people.”

What gradually moved many people, Chafee said, was hearing about friends and neighbors unable to purchase insurance, about people who went without and then got sick.

Chafee has been in economic development for more than four decades, he also argued the insurance problem holds back entrepreneurship in eastern North Carolina.

“I’ve heard instances in terms of where people said, ‘Well, you know, I might have been interested in going out and starting a company, but I didn’t want to lose my health insurance,’” he said.

Finally, he said the NCEast Alliance members started to understand the importance of extending insurance to more people, and what that would mean to the hospitals in the area.

“So you’ve got a number of different stories that come at you as to what motivates people to maybe finally respond and say, ‘Well, maybe that’s not such a bad thing. Because it would help an awful lot of people,’” he said.

You can’t get much further west in North Carolina than Graham County (courthouse pictured here), two-thirds of which is made up of the Nantahala National Forest. There are about 8,700 residents, with a median household income of $37,748, according to the NC Department of Commerce. Image courtesy: Wikimedia Commons Credit: Warren LeMay, Flickr/ Public Domain

‘Big loser’

The more people get beyond the rhetoric of opposing Medicaid expansion, the more they support it, said Sophia Paulos, the economic development director for Graham County.  She said that when her commissioners heard how 600 Graham County workers would qualify, that the county would gain about $44,000 in tax revenue and the policy would spur almost a million dollars in economic growth per year, the decision to support it became a “no brainer.”

She’s also come to realize that it wasn’t Obamacare, per se, that caused people’s premiums to rise. Instead, the problem was people’s lack of coverage.

“They show up at the ER, and they’re in some kind of catastrophic health situation and now they can’t pay, because they have no semblance of insurance, they’re never going to be able to pay that bill. And so your premiums just went up because that’s how we afford to keep the hospital open,” she said. “And when I explain that to people, they were like, it made sense.”

The information helped change Wiggins’ mind too.

When Berger wrote back to Wiggins saying that “Medicaid expansion has busted budgets in other states, and studies show that Medicaid is an inefficient and ineffective government program that fails to improve health outcomes,” he fact-checked him.

A man in a suit hands out papers to people sitting in chairs with laptops, some television cameras are also in the room. Brger has long opposed Medicaid expansion.
Senate leader Phil Berger (R-Eden) hands out information during a press conference in June, 2019. Photo credit: Rose Hoban Credit: Rose Hoban

“You know, in today’s world, it’s as easy as picking up your laptop or go to your computer and Google ‘What’s Medicaid expansion done in other states.’ You know, you get page after page that comes up, and they’re all highlighting all the good things that have happened,” he said. “You have to search multiple pages to find somebody that’s unhappy with Medicaid expansion in their state.”

He said that he doesn’t care what the national, or even the state party said he was supposed to believe.

“These people who need this assistance, who need this medical care, are people I know. They’re my neighbors, they’re my friends. So how can I go look them in the eye and say, ‘You know, the party says that we can’t support this, I’m not gonna support it,’” Wiggins said. “All the statistics bear out the fact that North Carolina has been a big loser.”

Correction: This story originally misidentified the photographer of the picture taken by Jill Hammergren.

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Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...