JEFFERSON — Gov. Roy Cooper visited Ashe Memorial Hospital to discuss Medicaid expansion with members of the hospital staff and board of trustees, the Ashe County Board of Commissioners, N.C. Rep. Ray Russell (D-Boone), business owners, local hospitality and health care providers on June 28.
“Having grown up in rural Eastern North Carolina, I know the challenges of rural health care,” Cooper said. “A lot of people here are living on the margins — right on the edge — don’t have health insurance, often wait too long to get treatment, oftentimes don’t get preventative treatment.”
According to Cooper, Medicaid expansion has the potential to provide an additional 1,152 Ashe County citizens with health care, in addition to bringing 100 jobs to the county, creating some $36 million in economic activity, plus $340,000 in annual county revenue, all while lowering the average citizen’s price of health insurance by 7 percent with no need for additional state taxes, partly because taxpayers’ federal taxes already benefit Medicaid expansion in other states.
Of the 50 United States, 37 have elected to expand Medicaid since the option was first offered by the federal government in 2013, Cooper said. Since 2013, North Carolina has turned down some $20 billion in Medicaid money from the federal government, according to Cooper.
“Particularly to rural hospitals, Medicaid expansion is so important to our community,” AMH CEO Laura Lambeth said. “In the past five years, we’ve written off $25 million because we don’t turn anyone away. There is a large percentage of people in Ashe County that don’t qualify — I just shudder to think how that Medicaid money is going out of state to help other people.”
According to Hobart Davis of the AMH Board of Trustees, 65-70 percent of patients at the hospital are either on Medicare or Medicaid during any given month.
Cooper said Medicaid expansion would mostly benefit the working poor, such as people who work for small companies who cannot afford to provide health insurance, but are making too much to qualify for the current Medicaid system, and have thus fallen through a coverage gap.
Across the state, some 500,000-600,000 citizens will become eligible for health care benefits if Medicaid is expanded, Cooper said.
“Today I vetoed the budget, partly because it didn’t address health care coverage, but there are ways to do this that Republicans and Democrats can agree on,” Cooper said. “Where there are differences of opinion on how to do it, we can roll up our sleeves and negotiate and get it done.”
In an email dated July 1, N.C. Sen. Deanna Ballard (R-Blowing Rock) said the compromise budget Cooper vetoed Friday included a provision to call a special session to consider access to health care across North Carolina later in the year, including issues pertaining to health insurance, association health plans, Medicaid and Medicaid expansion, but because the budget was vetoed, no such special session will occur.
“Supporters of Medicaid expansion claim it will provide insurance coverage for approximately 500,000 people that don’t currently have coverage,” Ballard said in the email. “The truth is, approximately 300,000 of those 500,000 — 60 percent — are either eligible for government-subsidized health coverage through the federal exchange or are already receiving health insurance through their employer.”
Chilton Rogers, retired from the North Carolina Rural Center, said the expansion of U.S. 221 will bring new growth to Ashe County, but people will not relocate to Ashe unless local health care is strong and growing. Additionally, Ashe’s aging population demands adequate emergency services and health care, Rogers said.
Ashe County Chamber of Commerce Executive Director Kitty Honeycutt said health care is a topic that arises without fail in her discussions with people considering relocating to the High Country area.
“People are thrilled to realize the expanded offerings that (AMH) has worked for so passionately and offered, such as oncology and orthopedics and so forth,” Honeycutt said. “We have to keep this hospital alive and well for not only our locals, but the folks who are moving here — and yes, we are an aging population, so it becomes even more important.”
Karen Powell — public relations administrator for SkyLine SkyBest, chamber of commerce board chairwoman and a member of the AMH Board of Trustees — later reiterated the statements made by Rogers and Honeycutt.
Likewise, Ashe County Board of Commissioners Vice Chairman William Sands said AMH is essential because its presence draws people and industry to Ashe County. Then he posed a question.
“Everybody I’ve talked to in the medical field is for it,” Sands said. “I heard you say no tax increase — is it going to be costly to the county, or to the state?”
In response to Sands, Cooper said that whether or not people agree with how much the government should be involved in health insurance, the issue has already been decided at the federal level.
“We are allowed to raise the income level of somebody who can qualify for Medicaid, and we can draw down about $4 billion a year — the federal government is paying 90 percent of that,” Cooper said. “What we are going to do so there are no additional tax dollars is put an assessment on insurance companies and other medical providers in order to be able to make up that 10 percent of the state tax.”
“This is something that’s already decided,” Cooper said. “We are paying our federal tax dollars to Washington, and we’re not drawing this down — we’re scraping as much money as we can, our transportation money we’re trying to get, we’re trying to get as much education money as we possibly can, we’re trying to get disaster recovery money but then we’re turning down health care.”
Regarding the potential for the federal government to decrease or altogether stop support for Medicaid expansion, Cooper said it would require affirmative action from the president and both chambers of the federal legislature, and the last two years are evidence that a halt in funding will not happen.
“Some states have put it in their legislation when they passed Medicaid expansion, they said, ‘if the feds reduce, then we stop,’” Cooper said. “There are ways around this, and ways to fix it, and I think it’s time for people — particularly in rural areas, where we have seen significant improvement in health because of this — it is really time to expand.”
Sands said Medicaid expansion seems logical, especially for a rural county like Ashe.
Dr. Kevin Kurtz, family medicine specialist at AMH, said the policy makes sense economically, health-wise and for care providers, given the numbers. Dr. Gregory Adams of Blue Ridge Pediatric & Adolescent Medicine added that there is a moral argument in having a heart for those who cannot afford health care.
“There’s been a bipartisan bill introduced in the House to do it, we’ve just got to get the leadership to agree to let us negotiate,” Cooper said. “Right now, the Republican leadership has told me that it is not on the table for the budget next year.”
Because the state budget from 2018-2019 will go into effect with the new fiscal year beginning July 1, the state government will not shut down like the federal government would, giving lawmakers time to negotiate on Medicaid expansion, which is a top priority for passing the budget, along with teacher pay, corporate tax cuts, investments in infrastructure and other issues, according to Cooper.
“There is no legitimate reason not to do this,” Cooper said. “The reasons that have been given now are demonstrably false, so I think we’re at a real crossroads, and it needs to happen now — in the next month, while we’re talking about this $24 billion budget.”
Cooper said North Carolina citizens should call their state representatives to voice their opinions on Medicaid expansion.
“Our state’s Medicaid program already covers low-income parents, children, pregnant mothers, the elderly, blind and disabled — expanding to insure able-bodied, single, childless adults would prioritize funding and access over our most vulnerable citizens in the state,” Ballard said in the July 1 email. “I will continue to discuss with our hospitals and local physicians, as I have done over the last year, while also keeping in mind anticipated costs and state budget concerns — in other states across the country, Medicaid expansion costs are nearly 50 percent higher than anticipated.”