Expanding Medicaid has divided Republicans in North Carolina’s General Assembly — and in states across the country. Now it’s become an issue in the Republican primary runoff in the state’s 3rd Congressional District.
Joan Perry, a Kinston pediatrician, said state Rep. Greg Murphy, a Greenville urologic surgeon, is trying to expand Medicaid in the state, a move that is opposed by N.C. Senate Republicans.
“It’s an expansion of Medicaid by another name,” Perry told The News & Observer in a phone interview.
Murphy has twice co-sponsored legislation — in 2017 and in 2019 — to expand health insurance to lower-income state residents by taking advantage of the federal government’s Medicaid dollars. More than 1 million North Carolina residents, about 11 percent of the state’s population, do not have health insurance, according to the Kaiser Family Foundation. North Carolina is sixth among states in total uninsured.
But he has worked hard to avoid calling it Medicaid expansion. In 2017, Republicans Donny Lambeth, Josh Dobson, Donna White and Murphy called their legislation Carolina Cares. In 2019, the four introduced NC Health Care for Working Families.
“Contrary to what has been reported in various media outlets, this is not an expansion of the fiscally uncertain Federal Medicaid program. Carolina Cares is a conservative and fiscally responsible alternative to Medicaid expansion that would not add a single person to the already 2 million North Carolinians on the Medicaid rolls. It is an entirely different insurance product,” he wrote in a February column entitled “Carolina Cares is conservative option to expansion.”
“I have pushed forward a common sense, fiscally conservative way to provide health insurance for well over 300,000 hard-working North Carolinians who currently have no coverage. These are farmers, fisherman, small business owners, even members of our clergy.”
Murphy’s campaign did not respond to calls and emails from The News & Observer for this story.
Murphy and Perry finished first and second in the 17-candidate Republican primary in April. They will meet in a July 9 primary to determine the Republican nominee for the general election. Murphy earned 9,530 votes, good for 22.5 percent of the vote, but short of the 30 percent needed to avoid a runoff. Perry won 6,536 votes or 15.4 percent.
The 3rd District is a sprawling one that stretches across all or part of 17 counties in Eastern North Carolina and includes much of the state’s coast. The seat was held by the late Rep. Walter Jones, a Republican who was in office from 1995 until his death in February.
States have the option of expanding Medicaid under the 2010 Affordable Care Act, often known as Obamacare. Thirty-six states, plus Washington, D.C., have expanded Medicaid or adopted but not implemented expansion. North Carolina is one of 14 states that have not, a group that includes several Republican-led Southeastern states — South Carolina, Tennessee, Georgia, Alabama, Mississippi and Florida have not expanded, according to the Kaiser Family Foundation.
But other Republican states, including Indiana under now-Vice President Mike Pence, West Virginia, North Dakota and Montana have adopted some form of expansion. Indiana’s program is called the “Healthy Indiana Plan.”
Murphy said North Carolina spends $800 million to fund Medicaid expansion in other states.
The federal government pays for 90 percent of the costs of Medicaid expansion under the Affordable Care Act. Murphy’s legislation would include people who make too much to qualify for Medicaid, but often not enough to afford health insurance on the private market. The bill would offer insurance to those 19 to 64 who meet federal Medicaid citizenship and immigration requirements making less than $16,142 (single) or $34,248 (for a family of four), which equals 133 percent of the federal poverty level.
He said the plan is a “fiscally sound, common sense solution that provides excellent health insurance coverage for those who are willing to accept a perfectly reasonable amount of personal responsibility.”
The legislation would require a premium (2 percent of household income) and co-payments by the insured. It also includes work requirements. The bill assesses additional fees on hospitals to cover the state’s portion of the cost. And it would be canceled if the federal government lowered its contribution to less than 90 percent.
“My opposition to Medicaid expansion reflects fiscal responsibility,” Perry said. “Expanding this program is going to threaten our education or business climate in the state.”
Perry said she prefers the federal government give the state money in block grants, long a favored plan for Republicans. In its 2020 budget, the Trump administration proposed Medicaid block grants as a way “to help set Government healthcare spending on a sustainable fiscal path,” according to its budget proposal.
“When they provide the set amount of money, the state decides how to allocate this. That gives the state a lot of control and a reasonable means of cost control.”
The winner of July’s runoff will face Democrat Allen Thomas, Libertarian Tim Harris and Constitution Party candidate Greg Holt in the Sept. 10 general election. Thomas, the former mayor of Greenville and former executive director of the North Carolina Global Transpark in Kinston, won 49.9 percent of the vote in the six-way Democratic primary.
The district is considered a safe Republican district. President Donald Trump carried the 3rd District by more than 23 points in 2016, according to district-level election data analysis by Daily Kos.
Perry has been endorsed by current U.S. Reps. Virginia Foxx and George Holding of North Carolina, Rep. Cathy McMorris Rodgers of Washington, Rep. Liz Cheney of Wyoming, Rep. Elise Stefanik of New York, who was the youngest member of Congress in the last session, and former Rep. Sue Myrick, the first Republican woman to represent North Carolina in Congress. Foxx, McMorris Rodgers, Stefanik and Cheney are four of just 13 Republican women currently serving in the U.S. House.
“Being a pro-life pediatrician allows me to speak to this issue with particular expertise,” Perry said. “For me, this would not be another notch in my political belt. I really consider it a a calling.”
Murphy, in his third term in the statehouse, has been endorsed by Rep. Mark Meadows, chairman of the House Freedom Caucus, and Women For Trump. Murphy visited Capitol Hill and members of the Freedom Caucus last week. He launched television and radio ads touting his relationship with the conservative faction of the Republican House.
“You have to be invited to be a member of the Freedom Caucus, but you have to have a backbone of steel. Many members who run have a backbone of a banana; when you peel it back it gets real mushy,” Meadows said on camera in the ad.
“I can tell you having talked to both candidates, giving them the opportunity to express their support of the values that the Freedom Caucus actually puts forth, there was only one doctor in this race that was willing to be a conservative and step up, despite the target it might put on their back. That doctor was Dr. Greg Murphy.”