By Anne Blythe

Gov. Roy Cooper presented a $25 billion budget proposal on Wednesday that would include a $988 million health care infrastructure limited obligation bond to support vaccine development, public health labs and health facilities at a time when interest rates are extremely low.

The spending plan, which he titled Support for a Determined North Carolina, outlines how he recommends spending more than $978 million in remaining federal coronavirus relief funds that must be spent by Dec. 30.

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Cooper also proposes shifting unspent state money from the Opportunity Scholarship Program, a favorite among Republicans that provides state vouchers for children attending private schools. The funds would instead support one-time bonuses for 138,000 teachers, principals, teacher aides, bus drivers and office support staff in the state’s K-12 schools. About 35,000 University of North Carolina system employees and 18,000 community college system workers would also see a bump in their paychecks.

Cooper renewed his call for lawmakers to expand Medicaid, which would enable the state to tap federal dollars that have been available for years and now flow to all but North Carolina and 11 other states which have refused to enact the policy. Such expansion, available under the Affordable Care Act and steadfastly resisted by Republican lawmakers at the head of the General Assembly, would provide an estimated half-million low-income workers in North Carolina access to the health care benefit.

The federal government would pay 90 cents out of every dollar spent on care under existing rules. Providers and insurance companies would pick up the rest.

“The budget I propose takes on the challenges of today while building for the promise of tomorrow,” Cooper said Wednesday during a briefing with reporters. “We have to rise to the occasion of this pandemic response now and focus on ways to emerge from this crisis stronger than before.”

GOP quick to respond

The governor presented his budget proposal less than a week before the General Assembly is scheduled to return for a short session that begins Sept. 2.

Republican lawmakers, particularly from the state Senate, responded to the plan with criticism and a common “spend now, pray later” theme. They hearkened back to the term of Gov. Bev Perdue, the Democrat in office when the Great Recession hit and layoffs and salary cuts followed.

“This ‘spend now, pray later’ budget strategy resulted in teacher salary cuts and layoffs when the last Democratic governor tried it,” Sen. Harry Brown, an Onslow County Republican, and Sen. Kathy Harrington, a Gaston County Republican, said in a joint statement posted to Sen. Berger Press Shop Medium site. “The Governor is ignoring warnings from nonpartisan budget experts so he can produce a four-months-late budget proposal that reads more like a prop from an episode of ‘Veep.’”

In early May, Republican legislative leaders and Cooper signed a $1.5 billion pandemic relief package and were in rare unanimity in supporting the same goals and spending plan.

Since then, there has been a return to partisan jabs between the branches, in particular with salvos coming from Senate leaders, as the November election draws closer.

For much of 2019, Republican lawmakers and Cooper were locked in a stalemate that brought the year to a close without a formally adopted budget.

Cooper vetoed the lawmakers’ spending plan, in large part because it did not include as much as he wanted for public school teachers and failed to expand Medicaid.

Instead of hammering out a compromise, lawmakers adopted a series of mini-budgets that kept state funds flowing to departments while ignoring the issues that divided the legislative and executive branches.

Will NC expand Medicaid?

It’s unclear whether there will be a change of hearts next month when the short session gets underway, but that has not stopped the governor from trying again to sway some minds.

“Medicaid expansion is perhaps the most important decision we can make right now to save lives, protect people’s health, boost our economy with billions of federal dollars, and save our rural hospitals, and it won’t cost the state anything,” Cooper said, his voice more impassioned than his typical soft-spoken, low-key style. “North Carolina is one of only 12 states that still hasn’t expanded Medicaid – even Indiana did so when Vice President Mike Pence was their governor. As people find themselves suddenly without a job, underemployed, without the health care they counted on, we have a solution.”

Cooper said expansion would help workers in day cares, restaurants, small businesses and more as coronavirus casts a harsh spotlight on long-standing health care disparities.

“Being able to see a doctor when you’re sick shouldn’t be a luxury,” Cooper said. “Taking care of people’s health during a global pandemic shouldn’t be a question. We can expand Medicaid right now if the legislature would agree. Though it’s been overdue for years, there’s never been a better time or a greater need to do the right thing.”

Health-related spending

Cooper said his budget proposal, which also calls for increasing unemployment benefits to $500 for 24 weeks, higher than the $300 for 12 weeks currently offered in this state, does not call for a tax increase.

Numerous health-related line items are in Cooper’s spending proposal. It includes:

  • $200 million in coronavirus relief aid for local governments.
  • $50 million for high-speed internet access expansion, which has provided access to telehealth, remote school learning and other necessary services in rural reaches and communities of color during the pandemic.
  • $25 million for NC Community College system health care and first responder programs.
  • $17.5 million for a public-private partnership with Catawba Valley’s Manufacturing Solutions Center, Gaston Community College’s Textile Technology Center and the private sector to launch a program to create reusable personal protective equipment.
  • $48.9 million to create a Strategic State Stockpile of PPE and testing supplies.
  • $20 million for state parks and trails, which have proven to be popular outdoor places for North Carolinians and others during the pandemic.
  • $25 million to UNC-Chapel Hill for equipment and research to help break down barriers to rapid COVID-19 screening.
  • $2 million to the Duke University Human Vaccine Institute to supplement the $15 million appropriated earlier this year in the race for a safe and effective vaccine and low-cost COVID-19 testing.
  • $1.08 million to support the North Carolina Pandemic Recovery Office for six months into 2021 after allocated federal funds expire.
  • $132 million for the Department of Public Instruction to help K-12 public schools respond to COVID-19 and purchase personal protective equipment, cleaning and sanitation supplies, food delivery, and increase access to broadband and internet connectivity.
  • $75 million to the UNC system for similar pandemic response needs.
  • $30 million to the NC Community College system for pandemic response.
  • $50 million to the state Department of Health and Human Services to address disparities in historically marginalized and rural communities that might need nutrition assistance, medication delivery and wraparound support systems.
  • $40 million to DHHS for Early Childhood Services to help support child care providers with personal protective equipment, sanitation supplies, early educator bonus payments and grants to facilities to offset revenue losses related to the pandemic.
  • $30 million to DHHS for mental health crisis services.
  • $25 million to DHHS for the expansion of testing, contact tracing and analysis of trends and metrics that guide decision-making in response to COVID-19.

CDC changes testing guidelines, NC does not

The proposal to add to the testing and tracing funds came on a day when the Centers for Disease Control and Prevention changed its guidelines for testing to exclude people who show no symptoms but work in high-risk jobs or have been in other risky situations.

Mandy Cohen, secretary of the state Department of Health and Human Services, was asked about the change on Wednesday during the briefing with reporters.

Cohen and Cooper stressed that they wanted people in North Carolina to continue to get tested for coronavirus, especially if they had been in a crowd or worked in high-risk settings. She also said that return times for tests have been falling in North Carolina after stretching to as much as 10 days to get a result in recent months.

Neither Cooper nor Cohen knew why the CDC quietly changed its guidelines.

Cohen said her public health team had raised concerns while also pointing out that the new guidelines deferred to state recommendations.

“We want more people to be tested,” Cooper said. “We think even asymptomatic people who think they may have been in contact or think they may be at risk in any way to get tested. This gives us the information that we need in order to put together contact tracing and it allows people to know that they need to quarantine themselves to protect their family and their friends.”

Coronavirus by the numbers

According to NCDHHS data, as of Wednesday afternoon:

  • 2,606 people total in North Carolina have died of coronavirus.
  • 158,985 have been diagnosed with the disease. Of those, 1,004 are in the hospital. The hospitalization figure is a snapshot of people hospitalized with coronavirus infections on a given day and does not represent all of the North Carolinians who may have been in the hospital throughout the course of the epidemic.
  • 136,630 people who had COVID-19 are presumed to have recovered. This weekly estimate does not denote how many of the diagnosed cases in the state are still infectious.
  • To date, 2,121,001  tests have been completed. As of July 7, all labs in the state are required to report both their positive and negative test results to the lab, so that figure includes all of the COVID-19 tests performed in the state.
  • People ages 25-49 make up the largest group of cases (42 percent). While 13 percent of the positive diagnoses were in people ages 65 and older, seniors make up 79 percent of coronavirus deaths in the state.
  • 358 outbreaks are ongoing in group facilities across the state, including nursing homes and correctional and residential care facilities.
  • There are 3,308 ventilators in hospitals across the state and 950 ventilators in use, not just for coronavirus cases but also for patients with other reasons for being in the hospital.

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Anne Blythe, a reporter in North Carolina for more than three decades, writes about oral health care, children's health and other topics for North Carolina Health News.