Standoff over Medicaid and budget drags on. For the uninsured, there’s a lot at stake.

News & Observer (Raleigh, NC)

Jul. 17--RALEIGH -- Adrienne Hayes-Singleton falls in the Medicaid coverage gap, which would close if the state says yes to full Medicaid expansion.

Hayes-Singleton, 36, of Wilmington, works in early childhood education and makes too much money to be covered under Medicaid as the program stands now in North Carolina. Her children are on Medicaid, and her husband, a disabled veteran, gets free health care, she said. But she doesn't, and is the only steady income in her household.

Hayes-Singleton said she can't afford a $500 emergency room bill, much less a $5,000 one.

"Make it accessible to us, that's all I'm asking," she told Gov. Roy Cooper on Wednesday morning at a Medicaid expansion roundtable Cooper hosted at the Andrews-London House in downtown Raleigh.

Cooper has been holding discussions with North Carolinians who would benefit from Medicaid expansion, which the state has not approved. The governor, a Democrat, has been putting pressure on Democrats to uphold his veto of the state budget that doesn't contain Medicaid expansion.

Budget standoff

The House, which is majority Republican but needs at least seven Democrats to vote with them to override Cooper's budget veto, has a veto override on its calendar but has yet to take a vote. House Republicans have also presented a compromise bill which would expand Medicaid but include a work requirement and premium of 2% of their annual income, billed monthly. But if it passed the House, it still would have to get through the Senate, too.

Senate leader Phil Berger told reporters on Tuesday that the problem with budget negotiation conversations "are predicated on, you have to pass something that satisfies the governor on Medicaid expansion before you can get to anything else."

Berger said it doesn't make sense to hold up a $24 billion budget over one item.

The fiscal year started July 1 -- more than two weeks ago -- and the state's budget from last year rolls over until the new budget is passed.

Berger's response to a question on what he thought of the House compromise bill was: "A rose by any other name would smell the same."

Cooper said Wednesday it's the Republican leadership, not rank-and-file members, who are holding up negotiations.

Senate Majority Leader Harry Brown, a Jacksonville Republican, said in response to Cooper's comments Wednesday that leaders "have never said it's our budget or nothing."

"A $24 billion budget shouldn't be held hostage over a single policy disagreement. But every time leaders try to negotiate a budget with the Governor, they are told that Medicaid expansion is a pre-condition of passing any budget," Brown said in a statement.

"Regarding the cop-out line that Medicaid expansion 'has to be part of the conversation' -- it is. Republicans offered a special legislative session dedicated solely to the Governor's top priority, and we even included that in the budget. That makes Medicaid expansion 'part of the conversation.' But the Governor refused, insisting again that Medicaid expansion pass into law before a budget is passed," Brown said.

Cooper said the House compromise that includes a work requirement can be a problem for people who had been working but then have an illness that prevents them from working. As far as premiums, he said that "we're talking about people who are living on the edge already anyway."

Even so, Cooper said that's on the table.

"There are arguments against those things, but my point is I'm willing to discuss all of them and put them on the table about how we go forward," Cooper said.

The governor said the expansion is not the creation of a new program or new state tax dollars out of the budget. However, he still wants it to be part of the budget conversation, not a separate session as has been proposed.

"[Republican House and Senate] leadership has said we want this budget that we put together in the back room, or nothing," Cooper said.

"Why is that off the table in budget negotiations? That's not right. ... We're talking about billions of dollars coming down; the budget is the place where this needs to be debated and decided. So we're hoping over the next few weeks that they will finally give up with veto override and come to the negotiating table and talk about these issues," he said.

Cooper said he also wants to negotiate over teacher pay and school construction.

Medicaid coverage gap

People who make too much to qualify for existing Medicaid, but too little to be eligible for federal subsidies for private insurance.

Lynne Price Pierce of Saxapahaw falls in the Medicaid coverage gap and said she doesn't make enough money to cover any health insurance premiums she can find.

Pierce, a single mother, is director of the nonprofit Southern Alamance Family Empowerment, a food pantry. She said Medicaid expansion would change her daily life by allowing her to get the medication she needs and go to the doctor when she needs to. Pierce has diabetes and high blood pressure.

"I'm not asking for a hand out," she said. "I'm just asking for help."

Ricky Clay of Roanoke Rapids is also in the coverage gap. An industrial electrician, he has spine problems and previously was addicted to pain medication. He served time in prison for selling his prescriptions, Clay said, and is working now without insurance coverage.

"I feel if we say yes to this Medicaid [expansion] it will help a lot of people, a lot of families," he said.

Rachel Radford of Wayne County described herself as a Cooper supporter in a Republican county that is not happy with the Democratic governor right now. She has bipolar disorder and two children with autism and her husband also has autism, she said. She is a stay-at-home parent because of her special-needs children, she said. Radford also has fibromyalgia and gets migraines.

Her husband's job at $14.40 an hour is not a living wage, she said, and they fall in the Medicaid coverage gap.

"I struggle every day," Radford said. She said they can't afford the $600 a month it would cost for health insurance through her husband's job.

Radford said she doesn't know what she'll do if Medicaid expansion doesn't happen and said she is "everything" to her children.

Department of Health and Human Services Secretary Mandy Cohen, who was also at the roundtable, told Radford there are DHHS respite care programs that can help "take care of you, so you can take care of them."

Pierce, the nonprofit leader in Alamance County, said that while she works, the House bill that would include work requirements doesn't take into account barriers that come with it.

"It's just not a black and white issue," Pierce said.

House vote

Rep. Donny Lambeth of Winston-Salem is a sponsor of House Bill 655, the Republican Medicaid expansion compromise bill called NC Health Care for Working Families. He said in a committee meeting this month that he knows there are emotions on both sides of the issue but that the bill was a start.

Rep. Donna McDowell White, a Clayton Republican, said she was proud to sponsor a bill that would "allow the working poor to have option to purchase their own insurance."

Neither the House bill nor the veto override were called up for a vote during the House session Wednesday, which was its last voting session this week.

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