With today’s hyper-partisan politics, it’s easy to lose hope that compromise can overcome our biggest challenges. But if six years as a Democratic governor with a Republican legislature has taught me anything, it’s that persistence and old fashioned coalition building still matter. Thanks to a dose of both, North Carolina is on the verge of finally expanding Medicaid for more than 600,000 people.
There are still 10 states that haven’t taken advantage of the Affordable Care Act to expand Medicaid to cover more of their citizens. I know advocates on the ground in those places are fighting hard, and I hope that the work we’ve done in North Carolina can offer a helpful battle plan.
For North Carolina, the arc of this policy change is long. Ten years ago this month, Republican legislators passed a law to block Medicaid expansion in North Carolina. In 2016, I campaigned for governor on the urgent need to extend health care to the working people in our state who need it. When I took office in 2017, I took action to expand Medicaid, and Republican legislators sued me in federal court to stop the process.
We could have set it aside then. But we didn’t. Too much was on the line.
Hundreds of thousands of hardworking North Carolinians are suffering in a health care coverage gap while a solution sat just out of reach.
In North Carolina, rural residents are 40 percent more likely to be uninsured and eligible for this Medicaid expansion than people who live in cities. Eleven rural hospitals have closed in North Carolina since 2005, with more at risk due to a lack of paying customers.
Our state, like others, has too many people in the grips of opioid and substance abuse. About 40 percent of overdose patients that come to our emergency departments are uninsured. That makes it harder for them to get the follow-up care they need, while businesses and their workers pick up the cost of their treatment by paying higher premiums. Of our almost 800,000 veterans, fewer than half receive care through the federal Veterans Affairs Department, with many going uninsured despite their service to our nation. Early childhood educators; restaurant staff; nursing home workers… The list of the commonly uninsured goes on far too long.
So, we persisted in our fight to make Medicaid Expansion a reality in North Carolina.
I’m deeply grateful for all of the advocates who pushed for it over the years. Nonprofit groups, businesses, health care professionals, people of faith, uninsured workers who bravely told their stories, Democratic and some Republican legislators, all who knew this was the right thing to do. But still, the legislation to authorize the health care laid dormant. We needed more to turn the tide.
To change the minds of Republican leaders, both the messengers and the message mattered. So, we expanded our coalition to feature non-traditional advocates who helped make the case.
Republican sheriffs, whose deputies grappled with people afflicted by substance abuse and mental health crises, know these people need health care, not handcuffs. Republican rural county commissioners who’ve watched their communities suffer when hospitals close. Local chambers of commerce that learned that more health insurance means a healthier workforce and lower costs for everyone.
Over the past several years we carefully and intentionally built this coalition. Our allies passed resolutions and personally visited lawmakers. We held public events in the districts of key members and created online resources with county-level data to show the benefits of expansion. We formed Care4Carolina, a broad coalition of businesses and nonprofits that worked to educate the public through advertising. I tasked members of my cabinet and staff to integrate a pitch for Medicaid expansion in their public appearances. And with time, as federal Medicaid expansion dollars continued to flow into other states, but not ours, all of this began to take hold. Support grew.
I give credit to Republican legislative leaders who were willing to change their minds and work with us to negotiate a solution that worked for North Carolina.
Medicaid expansion is a monumental investment that will save lives and bring our state $521 million a month in federal dollars. Our work in North Carolina is a reminder that obsessive partisanship only prevails when the people at the heart of these policy debates are forgotten. In North Carolina, we never forgot them. I’m confident that Medicaid expansion is a popular idea in the 10 remaining holdout states. For those who are pushing to make it happen, don’t let political games win. Keep fighting, get creative, and never, ever give up.
Roy Cooper is governor of North Carolina.
The views expressed in this article are the writer’s own.
welcome to your health-fighters.us