Three out of five commissioners voted against the interests of Transylvania County, leaving a big gap in health insurance coverage for working people, and instead recommended effectively giving away Federal taxes paid by NC citizens to 39 other states that have already expanded Medicaid.

Based on outdated “evidence” and following conservative dogma instead of common sense, on Monday, October 11, Commissioners McCall, Chappel and Chapman defeated a resolution that would have recommended closing the “coverage gap” in Medicaid insurance. Instead, they voted for a resolution specifically stating they were against the expansion, one that would help many working people in Transylvania County to cover healthcare costs. 

North Carolina is one of only 11 states that has not expanded Medicaid coverage. Across our state, nearly 1 million people fall into a “coverage gap”. Transylvania County ranks 13th highest out of North Carolina’s 100 counties in the number of uninsured working-age adults. 

What is this “coverage gap”, and what does it mean for North Carolinians? 

In North Carolina today, in order for an adult to qualify for Medicaid coverage one has to earn less than 42% of the federal poverty level. That’s less than around $9,000 a year. But to be eligible for federal subsidies for the Marketplace under the current plan, the same person would need to earn nearly $19,000. Anyone earning between those two figures is in the coverage gap. They simply can’t afford medical insurance, so most go without. 

Many of these uninsured who fall into the coverage gap in the western part of the state are working people, mothers and veterans. These folks work full-time or multiple part-time minimum wage jobs but earn too much to get care under the current Medicaid rules, but not enough to qualify for subsidies. 

“If you’re a mama with two babies — and it’s not uncommon to be a single mom with two babies — you don’t qualify for the federal Marketplace subsidies until you get to $21,000 a year,” according to Casey Cooper, CEO of the Cherokee Indian Hospital who’s been testifying before county hearings across Western NC. “If you make between $9,000 and $21,000 a year, you can’t get (subsidies enabling) coverage.”

“No one denies these citizens often go without basic medical services, including preventive screening procedures. And no one denies this situation is both a personal hardship for citizens and a social and economic calamity for North Carolina” former chairman of the Transylvania County Board of Commissioners Mike Hawkins wrote. (Transylvania Times 7/21/2021)

With the Medicaid expansion that was rejected by McCall, Chappel, and Chapman, nearly 2000 people in Transylvania County currently in this “coverage gap” would have gained access to coverage. 

Beyond providing better coverage to people in Transylvania County, expanding Medicaid would save the county thousands of dollars, and create jobs and revenue for the county. “Expansion-related reductions in inmate health costs alone would save Transylvania taxpayers $250,000 every year” according to Mike Hawkins. 

Commissioner David Guice confirmed Mike Hawkins’ claims. Guice, who brought forward the resolution, had prepared the ground before the meeting by sharing studies with the other commissioners showing that expanding Medicaid would have a positive impact on our county - improving healthcare, fighting the opioid crisis, and bringing positive economic benefits. On the other side of the argument were an older set of talking points that had been provided to the Republican commissioners. According to Guice, “Some of those talking points were ten years old. The evidence I shared was confirmed by the experience of other states. They either didn’t read it, or they ignored it.”

Putting partisan politics aside as he has throughout his long career in public service, Guice had hoped that the information he shared with his fellow commissioners would make the decision easy for them. He says he’s very disappointed that his colleagues on the county commission put political adherence ahead of the interests of their constituents. “I’m still bothered by this…  It’s not about ideology, it’s about truth… This was an important resolution that’s been passed by other rural counties like ours. The commissioners who came out against the resolution missed the boat on an issue of great importance and refused the opportunity to speak up for the people we were elected to serve.”

According to studies by Georgetown and George Washington University as reported by Care4Carolina, the same studies Commissioner Guice shared with the other commissioners, the county would benefit from $11,700,000 in new business activity, $198,000 in new county revenue, and 71 new jobs with the Medicaid expansion.  

Our federal taxes currently fund the 39 states that have already approved expansion, and the COVID-19 relief bill passed in March included more financial enticements for the remaining 11 states, including North Carolina, to expand Medicaid. Essentially, the federal government will cover 90% of the costs of the newly eligible population, and an additional 5% of the costs of those already enrolled. It's a good financial deal. An analysis by the nonprofit Kaiser Family Foundation estimates that the net benefit for these states would be $9.6 billion. 

The deal is so good, in fact, that other commissioners, even in conservative counties in WNC, have already approved resolutions calling for expansion. “We literally have people who are dying because they don’t have access to health care,” said Brian McMahan, chairman of Jackson County’s Board of Commissioners. “And if that’s not enough reason, the fact is that it’s a job creator. We can’t afford not to do it. It is not a Republican-Democrat thing at all. It’s what the needs are within our county and the people who need these services.”

Dale Wiggins, the former Republican chairman of Graham County’s Board of Commissioners has said. “What we have learned is if you cut out all the political rhetoric and just get down to the real facts of this issue... on a human being level, it’s not about Republicans. It’s not about Democrats, it’s about my neighbors, your neighbors, human beings. And in 2021, people need health care.” 

Our county commissioners claim that the highly touted Republican “Managed Care Plan” from Raleigh will solve the coverage gap, but this “plan” doesn’t take advantage of this federal funding, nor the Covid incentives. In fact, it’s still not clear if the plan, which was only launched in July, will actually cover many of those people currently falling into the coverage gap. 

The states that have refused to join despite the federal incentives have penalized their citizens out of political spite. Their dislike of the ACA has led them to ignore the positive health and economic benefits of Medicaid expansion. Those benefits have been confirmed by the experience in the 39 states that have adopted the expansion plan.

Sam Edney, chairman of the Transylvania Democratic Party and county native, was particularly concerned about those affected by the decision. “The three Commissioners who voted against merely recommending Medicaid Expansion made it clear that they don’t care about single moms, single women who work but can’t afford private insurance, and young families struggling to get by. Commissioner McCall made it clear in her comments that she doesn't understand the difference between Medicaid (a program which pays for healthcare) and the actual medical care people receive which is paid for by that program.”

The refusal of three of our county commissioners to close the coverage gap hurts working North Carolina residents. The anti-ACA politicians in Raleigh and right here in Transylvania County have shot themselves, and us, in the foot. Our elected officials need to raise themselves up above simple party ideology and act with common sense and knowledge of the facts. The county commissioners who derailed this resolution have done neither, and that will hurt our friends and neighbors in Transylvania County. Remember this at election time.