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Finding the flesh and blood in NC’s politicized Medicaid war

Health care advocates spoke of their children, co-workers and friends Tuesday as they implored state legislators to expand Medicaid and close the coverage gap.

North Carolina’s Medicaid coverage gap looks like Brenda Pernell, who went by “Miss Brenda” to her students and, until a heart condition killed her in April at the age of 52, treated her high blood pressure with vinegar. 

It looks like Jessica Jordan, who inherited her father’s blue eyes and her mother’s fiery hair and who, lacking the coverage to pay for mental health and substance abuse treatment, died from an accidental overdose last May at the age of 32. 

It looks like Lynn Pierce, a single mother from Saxapahaw with Type I diabetes who worries that a trip to the emergency room would derail her mortgage and car payments.

It looks like white people and it looks like people of color. It looks young and it looks old.

It looks like Democrats and it looks like Republicans. No one is inoculated from all illness, even if some face those illnesses with the crushing anxiety of bills they can’t pay.

“When you’re facing that fear, no matter what side of the political spectrum you come from, that’s wrong,” Pierce told Democratic lawmakers from the state House and Senate in a legislative committee room Tuesday. 

Democrats called it a hearing, although that is not, strictly speaking, true. A hearing would have required the participation of Republican leadership in the General Assembly. It was, then, an informal hearing, a hearing that was not a hearing, a hearing that the Republican leadership of North Carolina is not hearing.

Approximately 100 feet away, in the legislature’s press conference room, the Senate’s top Republican, Phil Berger, acknowledged the presence, at least, of a Medicaid gap while holding forth on lawmakers’ lingering budget impasse with Democratic Gov. Roy Cooper.

Republicans may lie about the time and place of a budget vote [2], but they have been, for all who care to look, savagely honest about the cold, callous ethos at the core of their Medicaid policy.

If this budget impasse was a baby, it would be old enough to roll over. And if Republicans’ mad blockade of the federally-funded Medicaid expansion was a child, it would have enrolled in kindergarten this fall.

Republicans may lie about the time and place of a budget vote [2], but they have been, for all who care to look, savagely honest about the cold, callous ethos at the core of their Medicaid policy.

Indeed, if Tim Moore and Phil Berger have accomplished anything during their ill-conceived and ill-executed leadership in Raleigh, it is convincing reasonable hearts and minds within the Republican caucus to abandon their hearts and minds on Medicaid. 

Leighton Ku, a professor of health policy and management at George Washington University — and the author of a pivotal report this summer on Medicaid expansion [3] — told lawmakers that, since 2014, the state has spent more than $8 billion on federal taxes. But it has not received a penny of the federal cash funneled to one massive component of Obamacare extending eligibility for the government insurance program. Indeed, North Carolina has missed out on more than $4 billion in federal dollars during that time, Ku explained. 

In 2013 — before any states could opt into the expansion — it was a Republican theory that the Obamacare program would bankrupt us all. But in 2019 — with 37 states having already expanded Medicaid, having already reaped billions in federal dollars — it is a failed theory. 

The expansion cuts the number of uninsured. It stabilizes rural hospitals, seven of which teeter on the brink of financial ruin in North Carolina today. It improves access to mental health care. And it would impact access to health care for those stricken by the opioid epidemic, which — from 1999 to 2016 — has killed more than 12,000 in North Carolina, four times the dead during the 9/11 terrorist attacks.

Speaker Tim Moore and Senate President Phil Berger.

There is reason to believe Republicans will someday break. Even if it is not in 2019, there are those within the party who are queasily receptive to a compromise, albeit one with a work requirement that may or may not be illegal. [5]  

But, to this moment, North Carolina’s Republican leadership has not moved on Medicaid.

Even if they have, under the duress of an appalled public, caved on HB2. And under the din of outraged teachers and parents, they caved on funding for lowered class sizes. And, under the order of a court, they will cave on their gerrymandered maps.

But not on Obamacare. Not on the healthcare of hundreds of thousands of North Carolinians. 

This is the hill that Tim Moore and Phil Berger have chosen for other people to die on.

“These are not abstractions,” Senate Democratic Leader Dan Blue bemoaned Tuesday. “These are real people.”

This is the hill that Tim Moore and Phil Berger have chosen for other people to die on.

Conservatives, predictably, jabbed at Democrats’ “sham hearing” Tuesday. On Twitter, one right-winger, lampooning the “boring as hell” nature of most legislative hearings, scoffed at the notion that the media or the public would attend a “fake hearing,” which they mostly did not.  

The state’s media, seemingly weary of this graying budget battle, hardly noted another round of cavernously sorrowful tales like those of Brenda Pernell, Jessica Jordan and Lynn Pierce, North Carolinians dead and living who, at the least, deserve to know that their stories are not a sham or tedious.

If politicians and pundits and reporters are so fatigued by that coverage, imagine the weariness of having lived this debacle. 

Searching for empathy, logic and sincerity in the Republican opposition to Medicaid expansion is like dropping a stone in a bottomless well, waiting for it to crack upon the bottom.

Lacking the coverage for hospitalization, Jessica’s mother, Robin, was advised by some that her daughter would turn her life around when she hit “rock bottom.” 

“Well, let me tell you, rock bottom was death,” Robin says. 

In Robin’s pained words, there is no space for politics.

And no matter how it is splashed in the newspapers and on the television, this is not a battle of Democrats versus Republicans, this is not a political horse race. This is the tent they erect around the fallen horse to avert our eyes from what comes next.