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How to break the stalemate in NC Medicaid expansion

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Democratic Gov. Roy Cooper vetoed the Republican-drawn state budget last week because it does not include Medicaid expansion. Senate leader Phil Berger (R-Rockingham) says Medicaid expansion will not be added. Period. Meanwhile, the fiscal year ended June 30 and the $24 billion proposed budget is in limbo.

One way to solve the impasse would be to let the people decide. The General Assembly could agree to put Medicaid expansion to a vote in 2020. Among the 36 states that have expanded Medicaid, four — Maine, Idaho, Nebraska and Utah — have done so through ballot initiatives. North Carolina does not allow citizens to put issues on the ballot through petition, but the legislature could agree to abide by the results of a referendum.

Gerry Cohen, a former special counsel to the N.C. General Assembly and an unofficial historian of the legislature, said use of a binding statewide vote has generally has been limited to bond issues and constitutional amendments. However, there were binding statewide votes on liquor sales in the 1930s and 1940s and one regarding county sales taxes in 1969. He said a binding referendum was widely discussed regarding adopting a state lottery, though legislators eventually pushed it through on their own.

Rep. Craig Horn, a Union County Republican and vice chairman of the House Appropriations Committee, said he prefers that lawmakers make decisions rather than turning that task over to the public. But he is open to considering a statewide vote. “At this point, every avenue is worth exploring,” he said. “We do not want to keep standing here looking at each other to see who blinks.”

Agreeing to put Medicaid expansion to a popular vote would open the way for lawmakers to negotiate other thorny, but less intractable budget issues. Prominent among those, on the governor’s side, would be bigger raises for public school teachers and blocking the proposed move of the Department of Health and Human Services from Raleigh to Granville County. For Republicans, taking the expansion issue off the table might move Cooper to accept yet another of their proposed corporate tax cuts.

The governor might oppose a referendum because it would further delay expansion of the health care plan for low-income families. He has the votes to uphold his budget veto and wants to apply pressure for expansion’s passage now. As Rep. Marcia Morey, a Durham Democrat, put it: “Time is of the essence. The more we delay, the more we deny people the health care they need.”

Berger and Republican leaders likely don’t want the people deciding this issue. Polls show that a clear majority of voters support expanding Medicaid. It’s easy to see why. Expansion would provide health insurance for hundreds of thousands of uninsured North Carolinians, create thousands of jobs and offer a lifeline to struggling rural hospitals. The federal government would cover 90 percent of the cost. Under Cooper’s plan, an assessment on hospitals and other health care providers would cover the other 10 percent.

Objecting to letting the people decide is a hard position for Republican lawmakers to take now. They, after all, spoke a lot about “the people’s will” when they put six constitutional amendments on the 2018 ballot. Those included big issues — a photo ID requirement for voting and capping the state income tax rate — and a frivolous one that protected the right to hunt and fish.

Why now be reluctant to let the people speak on the state’s most consequential matter?


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