I don’t know much more about Donny Lambeth than you do.

At one time he was the president of the Wake Forest University Baptist Medical Center. In this town, that’s a big honking deal. He’s also served for years as chairman of the Winston-Salem/Forsyth County Board of Education and now serves in the state House of Representatives.

Make all the jokes you want about politicians — I have and I will — but public service matters. Sure they spend (waste?) time on such nonsense as voting on an official state cookie or trying to establish something called the N.C. Golf Council. That bill, backed by 21 co-sponsors, is gathering dust in a committee. Just like some legislators.

The honorables will, on occasion, embarrass the state and cost us money. House Bill 2, the infamous Bathroom Bill, comes to mind. They can — and have — gone too far in trying to micromanage local affairs. Remember the ham-fisted attempt to reconfigure the Winston-Salem City Council? That was Lambeth.

But despite the monkeyshines, a lawmaker will on occasion step-forward with something that could actually make a real difference.

Lambeth has such an idea.

Not unreasonable

As things stand now, about 2.1 million state residents — one in five — use Medicaid, and more than half of those are children.

The program is administered by the N.C. Department of Health and Human Services and costs about $14.6 billion a year. Two-thirds of that cost is paid by the federal government.

Two years ago, a handful of Republican representatives pushed a radical (for them) bill by which they would provide a pathway for nearly a half-million of the poorest North Carolinians to get health insurance.

Smack in the middle of that handful stands Lambeth, Republican of Forsyth County and former hospital administrator. And they’re still at it.

The bill is complicated — name one thing involving health care that’s not — but here’s the gist:

Low-income folks, those earning between $25,000 and $34,600 for a family of four, who are trapped between outright eligibility for Medicaid and being able to buy their own coverage, would get access to health insurance through the state’s Medicaid program.

Basically, it would be North Carolina expanding access to Medicaid like 36 other states. The feds, under the Affordable Care Act, pick up 90 percent of the cost of the expansion. The most recent states to do so were Utah, Idaho and Nebraska — hardly bastions of liberalism.

We haven’t followed suit for two reasons. The leaders of the House and Senate, Speaker Tim Moore and Senate President Pro Tem Phil Berger, think it’s too expensive. That view isn’t too far removed from a scene in Mel Brooks’ 1981 movie “History of the World, Part I” in which Roman senators debating housing vote in unison: “(Screw) the poor.”

Anyhow, Lambeth’s bill — House Bill 655, or the “NC Health Care for Working Families Act,” is a little different than a straight Medicaid expansion.

It contains provisions for a work requirement, a buy-in (2 percent of a recipient’s annual income for premiums) and a requirement that participants engage in preventative care and wellness. It’s a lot cheaper to manage diabetes than lopping off toes and feet.

As for the work requirement, nobody’s asking for 40 hours in a coal mine. Ten or 20 hours at a part-time job never killed anyone, and there would be exceptions for the elderly, women caring for young children, kids themselves and those who are “medically frail.”

None of that is unreasonable.

Nor are the proposals to help pay the state’s costs. The bill would tax the managed-care companies that will soon run the Medicaid program and assess hospitals that will benefit by having fewer uninsured patients wander in with headaches and hangnails.

So why does any of this matter? And more importantly, why now?

Still in play

Gov. Roy Cooper and the General Assembly are on a collision course over the state’s $23.9 -billion budget for 2019-20.

Cooper, a Democrat, has been pushing for a version of the no-strings attached Medicaid expansion. Accept the 90 percent from the feds and figure a way to cover the state’s share.

The Republicans in charge of the Legislature, most of them anyhow, don’t want to have anything to do with expanding Medicaid.

Berger, Moore and others say that the federal government could pull the 90-percent funding guarantee and leave the state holding a very expensive bag. Others might argue that access to health care is a right and keeping it from the poor is, say, morally repugnant.

Either way, the proposal does contain a provision to end the state expansion in the event the feds pull the funding.

House Bill 655 hasn’t yet passed the Legislature. It’s not likely to, either, not anytime soon. But there is a scenario under which it might come into play as the honorable (and Cooper) work to finish the budget.

Say Cooper vetoes the budget and stands firm in his demand for Medicaid expansion. House Republicans no longer enjoy a veto-proof super-majority; leadership may have no other choice but to negotiate.

Compromise, in a democracy, needn’t be a bad word. If or when that happens, Lambeth has a bill that could help break such a deadlock and do some real good for North Carolinians.

That’s a far better use of time than debating cookies or naming an official battleship.

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ssexton@wsjournal.com 336-727-7481 @scottsextonwsj

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