By Anne Blythe, Hannah Critchfield and Rose Hoban

Ballots in North Carolina did not list Medicaid expansion, the Affordable Care Act, the coronavirus pandemic response or the economy as something registered voters could mark as for or against.

In the outcome of the 2020 elections, it appears that North Carolina voters were willing to have Democratic Gov. Roy Cooper continue to lead the state response to the COVID-19 crisis while giving more seats to Republicans to lead on fiscal policy in the legislature.

“Voters made a clear choice in support of the Republican platform of low taxes, expanded school choice, and large investments in education and teacher pay,” said Senate leader Phil Berger (R-Eden) in a statement released late last night. “The Senate Republican majority will continue to deliver on those promises.”

North Carolina saw an unprecedented number of registered voters cast their ballots early, either in person or by mail with absentee ballots.

As a result, many polling places across North Carolina were filled with more poll workers and observers than voters at times during the day.

In Vance County, turnout was light at several polling sites in Henderson, where party partisans said they were seeing only 10 or 20 people an hour. Many folks at Perry Memorial Library walked out of the polling place with a print out of the correct precinct for their votes. A Democratic party observer who declined to give his name said that by mid-afternoon about 30 people had been redirected to other polling sites.

Some voters said that health care wasn’t really at the top of mind as they walked into their voting places, but for those who were thinking about the issue, it loomed large.

Ashley Boone-Roach perked up when asked about health care.

“Sometimes when I hear  ‘Affordable Care Act,’ I just want to cry, because it saved my life, having it,” she said.

Standing in front of her polling place at the Richard Thornton Library in Oxford, Boone-Roach told of being a 26-year-old who had just gotten off of her parents’ insurance policy when she discovered she had blood clots. Then, when she got married, she wasn’t able to get insured through her husband’s policy because of her pre-existing conditions. Because of the ACA, she was able to get covered.

Now that she has a job and has health insurance through her employer, she said she hasn’t been held back because of that pre-existing condition.

“I’m a living witness, I wish I could write to the founders of that piece, and say, ‘It saved my life, I wouldn’t be alive today.’”

Chatham County sees high turnout

By the time Election Day got here, Chatham County already had seen 75 percent of its registered voters vote early or cast absentee ballots — the highest percentage in the state.

Man and woman at a campaign site wearing red Make America Great Again hats
Toby and Maggie Considine, Bynum residents, outside a Chatham County voting site. Photo credit: Anne Blythe

In Chatham County, Maggie Considine and her husband Toby Considine stood outside a voting site in Pittsboro wearing red Make America Great Again caps and face masks.

He voted Tuesday morning because he likes the excitement of casting a ballot on Election Day. She voted early. The Bynum couple was on the same page, though, when it comes to who they think should lead the country for the next four years.

Maggie, a realtor, said Trump represents “prosperity, freedom, hope.” “The Democrats seem to be selling recession, repression and fear,” she added.

Toby touted the pre-pandemic economy when asked why he wanted four more years. At 62, he downplayed the pandemic, and pointed to his stomach as his biggest COVID-19 problem, hinting at a weight gain he hoped to soon shed.

Maggie said she thought the president’s response to the pandemic “could have been better.” “I don’t think anybody else could have done better,” she added. “His job is to be a cheerleader.”

Pandemic response spurs votes

In the same parking lot, Ana Carlson-King, a 37 year old who lives in northern Chatham County, gathered with other Democrats handing out information about their recommended candidates.

Woman wearing a dark-colored face mask and hat
Ana Carlson-King, a Chatham County resident, outside a voting site on Election Day. Photo credit: Anne Blythe

The 2020 election, to her, is about access to health care, the disparities she’s seen for the Special Olympics swimmers she coaches in Orange County, especially those who live in group homes, the Republican resistance to expanding Medicaid and her concern about the repeated attempts to overturn the Affordable Care Act.

“To me, it’s coming down to the pandemic and it’s coming down to health,” Carlson-King said, voicing her support for Democrats.

Johnny Shaw, a 69-year-old retired educator who lives in southern Chatham, was outside the same Pittsboro voting site, handing out candidate recommendations for Democrats.

He’s flummoxed, he said, by Republicans’ unwillingness to expand Medicaid and had heard no reason from state legislators who refuse to take federal funds for a program that could help expand health services.

“It’s just sort of a party thing,” Shaw said. “It’s just, ‘We’re going to show you we’re not going to expand.’”

As a former teacher and school administrator, Shaw also said it is time to expand broadband, especially in a pandemic when so many schools have moved to online teaching to keep students, teachers and staff safe from COVID-19. He was critical of Republicans for the access issues plaguing many.

Man wearing a blue vest, face mask and ball cap stands under a blue tarp
Johnny Shaw, a Chatham County resident, discusses the 2020 election. Photo credit: Anne Blythe

The fight for state House and Senate

How the vote comes down for state legislative races will be crucial in determining whether access to care in North Carolina is expanded.

Since 2013, Republicans have had control of the General Assembly, initially with a supermajority and a simple majority since 2018. Party leaders have staunchly resisted expanding Medicaid to some half-million low-income workers, a policy made possible because of the Affordable Care Act.

Democrats were hoping to pick up more seats in the chambers, to break that logjam. Instead, the party lost at least four seats in the House and several in the Senate. Many races remain too close to call with as many as 136,000 absentee ballots unaccounted for.

Erica Palmer Smith leads Care4Carolina, a coalition that’s been pushing for expansion for years. She said she hoped the legislature would make it “a number one priority” going into 2021, that more than 500,000 North Carolinians gain access to affordable, quality health insurance.

Palmer Smith said she thought there could be a “solid chance” that something similar to earlier bills, which have included employment requirements or screening requirements for recipients, would be likely.

She noted that Care4Carolina’s polling has shown strong support for expansion among voters.

“A whopping 75 percent of North Carolinians in a statewide poll conducted in August ringingly declared that they want to close NC’s health care gap,” she said in an email to NC Health News.

Some voters echoed that support.

“I just need for that Medicare, Medicaid to be a little bit better than what it is now,” said Henderson resident Roselyn Fields. “You know, younger folks can’t get Medicare or Medicaid. So it’s kind of hard with people who got heart problems like me.

“That’s the only reason why I’m voting.”

But getting the legislation passed may be a heavy lift especially as Democrats have lost seats, and with it, leverage.

shows a Black woman in a mask worn against COVID standing in front of a polling station
Henderson resident Roselyn Fields came to the Perry Memorial Library in town to cast her ballot on Tuesday. She said that she has a heart problem so health care is a big part of her decision making when she thinks about voting. “I need for the Medicaid to be better than what it is,” she said. “It’s kind of heard when people who got heart problems like me… I think that’s the only reason I’m voting.” Photo credit: Rose Hoban

In the House, many of the Republican champions of the policy have moved on. Representatives such as Josh Dobson (R-Nebo), who co-authored Republican bills to expand, won’t be returning. He ran for state labor commissioner, a race he appears to have won.

Another expansion proponent, former state Rep. Greg Murphy (R-Greenville), has moved onto Congress, where he was reelected, and other Republicans, such as Rep. Craig Horn (R-Weddington), who publicly supported the policy, recently retired.

Resistance to Medicaid expansion has been fiercest in the Senate, where Berger has made it clear for the past few years that he’s against the policy and no such bill would have a chance in his chamber.

Palmer Smith said it’s been difficult to have conversations with leaders in the majority for the past several months leading up to the election.

“But a lot of the private conversations we’re having, legislators recognize that this is an issue and I think that we’ll see enough… to show that this is a major issue for voters,” she said.

Race, health intersect

In Alamance County, Miguel Tatum, age 36, and his son, a first-time voter, cast their ballots at the Graham Civic Center in Graham on Tuesday.

“This pandemic showed that health care really is important,” said Tatum. “A lot of black and brown people are dying. It’s important to get people in that really care.”

Miguel Tatum, 36, and his son, a first-time voter, cast their ballots in Alamance County today. Photo credit: Hannah Critchfield

Dreama Caldwell, who is both a voter and a candidate for county commissioner, said she voted to improve local responses to the pandemic.

“I’m a formerly criminal justice-involved individual, and that particular part of the population needs a voice,” said Caldwell. “Our Sheriff, Terry Johnson, has not enforced masks. So him and his law officers have not worn masks, and as a result the jail had 120-plus cases of COVID. It was only after that outbreak, in my understanding, that inmates were given masks. We’re a very reactive county, we’re not a proactive county.”

Caldwell finished last in a field of six.

Frontline workers explain their votes

Veretta Hatley, a 48-year-old Carrboro resident who works at the Croasdaile retirement community in Durham, cast her ballot in person after work on Tuesday at Carrboro Town Hall for Democrats.

Hatley, a Black woman wearing a pink Black Lives Matter face mask, said health care and what happens if the ACA is gone were on her mind when she voted.

Woman wearing a pink Black Lives Matter face mask outside a building
Veretta Hatley, a Carrboro resident who works at a Durham retirement community, outside a voting site. Photo credit: Anne Blythe

“Personally, my mother battled cancer last year, and I don’t want her not to continue with her care because she has pre-existing conditions,” Hatley said, mentioning others in her family who might be more reluctant or unable to afford care if they lost their insurance.

She also supports Medicaid expansion as someone who could benefit from it.

As an essential frontline worker, she praised Gov. Roy Cooper’s handling of the pandemic.

“I love him,” Hatley said. “He got a lot of criticism for not opening up some things as fast. They were saying, ‘Why don’t you open this? What about this?’ But I’m saying, ‘People are dying. I’m out here on the front line. I see it.’”

A certified nursing assistant from Oxford who only gave her name as Mary who worried about her older patients.

“I know if they take their Medicaid and Medicare away, they won’t be able to survive,” she said.  “That’s not fair to any American of this United States, Black, white, Hispanic part of this United States. They have helped make the United States great, they deserve their benefits with the work that they put in.”

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