Politics & Government

Will lawmakers expand Medicaid? CuriousNC looks into readers’ top 5 issues for 2019

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The legislature returns Jan. 30 to start working on new laws. CuriousNC asked readers “What is the most important issue facing the North Carolina legislature in its 2019 session?”

Here are their top responses and what’s likely to come up this year on those fronts.

No. 1: Expansion of Medicaid

This was the most popular choice for the top issue. Democratic Gov. Roy Cooper and Democrats in the legislature want to expand Medicaid, the government health insurance program, to more low-income adults.

Thirty-seven states, including Washington D.C., have expanded Medicaid, according to the Kaiser Family Foundation.

Under the Affordable Care Act, states can add adults who earn no more than 138 percent of poverty level to Medicaid, with the federal government picking up most of the cost. An estimated 339,000 people in North Carolina would qualify for health insurance under Medicaid expansion, according to a Kaiser Family Foundation report.

Republican majorities in the legislature have so far refused to debate expansion. But a version of Medicaid expansion, in which enrolled people would work and pay premiums, may have a chance in the House this session.

Four House Republicans in 2017 proposed to add more low-income adults to Medicaid under a program they called Carolina Cares, which would require enrollees to pay premiums and work. The bill was never debated in committee. Its sponsors plan to try again this session.

Republican Rep. Donny Lambeth of Winston-Salem, the lead sponsor, said in an email that the House members who sponsored the 2017 bill plan to revive the proposal this year.

“It is our judgment as conservative Republicans with extensive background in healthcare that this bill is absolutely necessary for North Carolina to meet the healthcare needs of our hard working citizens who simply can not afford health care. It will include a work requirement. It will not require any funding by the tax payers of NC and will actually save money by reducing the current subsidy provided to our states operated hospitals.”

House Speaker Tim Moore said he’s interested in the Carolina Cares plan.

“We are having a lot of conversations about the Carolina Cares approach that Rep. Lambeth has worked on,” Moore told reporters earlier this month. “This is an approach that, given the mandates that we’ve dealt with with Obamacare and the high cost that so many North Carolinians are paying all across the state for health care, some way if applicable to help those who are working but having trouble paying it.

“What we don’t want to do is simply expand just a handout and be a discouragement for folks to get jobs or get employment. But if there’s something we can do to help the working poor I think that’s something we ought to try doing.”

This marks a departure from two years ago, when Moore told The News & Observer he did not want Medicaid expansion.

The 2017 bill would have allowed adults whose incomes are at or below 133 percent of the federal poverty level to use Medicaid. They would have had to pay annual premiums equal to 2 percent of their household income, with some hardship exemptions. In most cases, adults would have had to be working or “engaged in activities that promote employment” to be eligible for the coverage, The News & Observer reported.

The federal government picks up most of the cost, but states have to pay for some of it. The bill would have had hospitals pay the state portion.

One of the 2017 sponsors, Rep. Greg Murphy of Greenville, said the working poor, including farmers, fishermen and clergy, can’t afford private insurance but make too much to qualify for regular Medicaid.

“I think we need to help those individuals in any way we can.” Murphy said in an interview. “A lot of those folks are the backbone of our community.”

Senate leader Phil Berger, an Eden Republican, remains opposed to any type of Medicaid expansion.

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In an email, Berger spokesman Pat Ryan said Berger would have to discuss any issue with other Senate Republicans.

“In his personal opinion, he has yet to see a proposal for Medicaid expansion that would not result in a massive debt burden on the state, as well as reduced access for traditional enrollees who find themselves competing for care with able-bodied, childless adults,” Ryan wrote. “Still, as with any issue, he’s happy to discuss creative solutions.”

No. 2: Election oversight and security

Allegations of fraud have left North Carolina’s 9th Congressional District as the country’s last undecided congressional race of the 2018 elections. The investigation includes reported mishandling of absentee ballots in Bladen County. Fraud claims date back to the 2010 and 2016 elections, The News & Observer reported.

The conservative N.C. Values Coalition unsuccessfully tried to stop Democratic Rep. Rachel Hunt of Charlotte from being seated over discrepancies between the dates voters signed absentee ballots and when witnesses or notaries signed, The Charlotte Observer reported.

Legislators required the State Board of Elections to develop photo identification rules for voters who request absentee ballots. The absentee ballot ID requirements are part of the new voter ID law, which deals mostly with in-person voting.

In an email from Moore’s office announcing the appointment of Republican Reps. Holly Grange and Destin Hall as chairmen of the House Elections Committee, Grange said the committee would conduct oversight hearings on absentee ballot laws and practices.

“We saw this election cycle and in previous years that there are unacceptable gaps in the integrity and reliability of our elections systems,” Grange said in the press release.

Two years of court fights over the makeup of the State Board of Elections between the Republican legislature and the Democratic governor resulted in a victory for Cooper. A new law returns the elections board to its pre-2017 configuration: five members with a 3-2 party split and all appointed by the governor.

A new board will be in place on Jan. 31 at the earliest, and will have three Democrats and two Republicans. The state political parties have nominated members.

A new law requires county boards of election submit reports on voter-list maintenance that tell they keep the lists up-to-date. Republican legislators have complained that voter data they use in campaigns is out of date and includes voters who don’t live at the addresses on record.

No. 3: Redistricting and voting rights

With issues like redistricting and voting, some of the action has moved from the legislature and into the courts. Two redistricting cases are pending. The U.S. Supreme Court will hear arguments in March whether congressional district boundaries are unconstitutional partisan gerrymanders. A lower federal court ruled that the district boundaries are unconstitutional.

A separate lawsuit in state court claims that legislative districts are unconstitutional partisan gerrymanders.

The results of these cases will determine whether legislators will be required to redraw district boundaries.

The state has two lawsuits pending over the voter photo ID law the legislature passed in December. The lawsuits claim that the law discriminates against minority voters. Supporters of voter ID maintain it offers “common-sense protections against voter fraud,” as Republican Sen. Joyce Krawiec of Kernersville did in a prepared statement in December denouncing the lawsuits.

A state elections board audit of 4.8 million votes cast in the 2016 general election found one case of in-person voter impersonation, The N&O reported.

The audit found 41 green-card holders who admitted to investigators that they were not citizens, and 24 people who voted twice. The investigation found 441 voters who appeared to be serving active felony sentences on Election Day. State law prohibits voting by people who are on probation or parole for felony convictions.

Alamance County charged 12 people with voting illegally, and was one of a handful of counties to bring charges against voters, The N&O reported. All 12 pleaded guilty to the lesser charge of misdemeanor obstruction of justice.

Public support for a system that takes redistricting out of the hands of legislators has grown more prominent in recent years. Legislators in the House and Senate routinely file bills that would establish a nonpartisan redistricting commission. A nonpartisan redistricting bill passed the House in 2011 with bipartisan support, but died in the Senate.

Jane Pinsky, director of the NC Coalition for Lobbying and Government Reform, said she expects redistricting bills to be filed again this session and the public pressure for changes to continue.

“Clearly, citizens have had it,” Pinsky said in an interview. “They see gridlock here and in Washington is detrimental to their interests. So I think people are going to push hard.”

No. 4: Gun control / gun rights

Debates on proposals that would loosen gun laws are routine in the legislature.

Since Republicans took control of the legislature in 2011, it has expanded the places people can carry concealed guns, The N&O reported.

In response to the high school shooting in Parkland, Florida, last year, a handful of Republican House members pushed unsuccessfully for a law to allow teachers to carry guns in schools.

Democrats in the legislature filed bills that would raise the age to 21 for buying what they described as assault weapons, open a way for courts to impose “extreme risk protection orders,” provide funding for school counselors and psychologists, and require background checks for purchase of semi-automatic weapons from private sellers. Those bills never came to votes. Democratic Sen. Jay Chaudhuri of Wake County said in an interview he and others would file the proposal with the package of changes again this year.

“As long as students don’t feel safe and secure, parents and students expect we will do all we can to create a safe environment,” Chaudhuri said.

He hopes that, at least, the proposal for extreme risk protective orders goes to a vote. The orders would allow courts to temporarily remove guns from people considered dangers to themselves or others.

The gun-rights group Grass Roots North Carolina vowed to fight the extreme risk protective order bills when they were proposed last year.

No. 5: Preserving public (free) education

Moore is backing a $1.9 billion school bond referendum for 2020. The legislature would have to vote to get the question on the ballot. Moore proposes most of the money go to building schools, and $600 million go to state universities and community colleges, The N&O reported.

Education policy and spending debates take up a big chunk of the legislature’s time. The long session will likely see a continuation of discussions about teacher pay, general school spending, money for pre-kindergarten students, and evaluating schools.

The debate about giving schools A-F grades and how those grades are calculated has raged for years. The emphasis for elementary schools is on test scores, with a smaller portion of the grade based on student growth.

The House has wanted to put more emphasis on student growth, but the Senate wasn’t interested. Education leaders maintained the grades are unfair to schools with high proportions of low-income students who show good growth but still don’t score well on tests.

That may change this year. Sen. Jerry Tillman, an Archdale Republican and one of the Senate Education/Higher Education Committee leaders, said he wants to talk about having the scores give greater weight to growth.

“I would like to take another look at the way we score and evaluate schools,” Tillman said. More emphasis on growth “is the fairest way to judge schools,” he said in an interview.

Tillman said he’d like more teacher raises in the budget this year, “making sure our teacher pay scale is doing well for those veteran teachers,” Tillman said. “Some of those have been left behind a little bit.”

This year’s salary schedule plateaus at $50,000 a year for teachers with 15 to 24 years experience, bachelor’s degrees, and no National Board Certification. Teachers with 25 years experience or more make $52,000. Most districts add in their own money to supplement the base state salary.

Prominent North Carolina business leaders are calling for money to increase enrollment in pre-kindergarten, the N&O reported. House Democrats said they expect proposals this year to increase pre-kindergarten funding.

The business leaders’ push comes soon after a study showed that Read to Achieve, the state effort to get students reading at grade-level by the end of third grade, has not worked, as The Charlotte Observer reported.

“A lot of the legislators are realizing that if we’re going to make third grade the benchmark for how kids are going to do in the future, we have to do a lot more to prepare them for third grade,” Rep. Rosa Gill, a Raleigh Democrat, said in an interview. “You’re going to have to deal with early childhood.”


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Lynn Bonner has worked at The News & Observer since 1994, and has written about the state legislature and politics since 1999. Contact her at lbonner@newsobserver.com or (919) 829-4821.