Health insurance (copy)

The headline, the baited hook on any story worth reading, was only a little misleading.

Medicaid expansion bill is put on fast track

In North Carolina, Medicaid expansion means different things to different groups.

To the working poor without health insurance, it’s life-changing — as many as 600,000 North Carolinians would have a shot at decent health care. For rural hospitals struggling to survive, expansion means more patients whose bills get paid. A path to solvency.

And to a certain subset of lawmakers in Raleigh engaged in a staring contest over the $23.9 billion state budget, Medicaid expansion is nothing more than a bargaining chip.

So, too, is a proposed move of the N.C. Department of Health and Human Services from Raleigh to the first county whose Democratic legislators are willing to buck the governor’s budget veto.

How much is a vote worth? We’re about to find out.

Impasse solutions

Admittedly, neither of those two subjects makes for enthralling dinner conversation: Medicaid expansion? Budget vetoes? … Are you drunk?

Maybe, but that’s not the point.

The issue is that the men and women we’ve sent to Raleigh to deal with actual problems facing our friends and neighbors are playing games.

To wit: The state House and Senate, controlled by Republicans, passed a compromise $23.9 billion budget two weeks ago. Gov. Roy Cooper, a Democrat, vetoed it the next day.

In past years, when the GOP enjoyed veto-proof majorities, House and Senate leaders simply would have steam-rolled Cooper’s veto. But that’s no longer an option since Democrats managed in 2018 to win enough seats in the House to sustain vetoes — if they all manage to stick together.

Republicans need seven House Democrats to stick a thumb in Cooper’s eye by voting to override his budget veto and just one in the Senate.

That’s not many.

To get there — a veto-override vote is set for today — Republican leadership in Raleigh tossed two fat carrots onto the table to tempt twitchy Democrats.

The first is the “fast-tracking” of a Medicaid-expansion bill sponsored by state Rep. Donny Lambeth, R-Forsyth. Democrats, Cooper especially, want that to happen. And Lambeth has figured a potentially bipartisan way to deliver.

His bill, called the “NC Health Care for Working Families Act,” would expand access for those earning between $25,000 and $34,600 for a family of four to health insurance through the state’s Medicaid program.

It hits the right notes for those singing from conservative hymnals — work requirements, a buy-in for participants (2 percent of a recipient’s annual income) and a requirement to engage in preventative care and wellness.

And if the federal government were ever to pull its guarantee to pay 90 percent of the cost of expansion, the state can bail.

If Medicaid expansion is in the mix, Democrats would likely pass the budget. No more impasses.

Bargaining chip

A second — and more cynical — carrot is dangling the possibility of moving the Department of Health and Human Services to whichever county can provide the most Democratic help in overriding the budget veto.

On its face, the proposed move sounds complicated. But it’s really not.

The state agreed in 2015 to sell the 307-acre Dorothea Dix property for $52 million to the city of Raleigh for a park. Since the N.C. Department of Health and Human Services is there, it will eventually need a new home.

Naturally, the move wound up a bargaining chip in political games. You expected something different? Are you drunk?

Maybe a little, but that’s not the point.

Forsyth, Granville, Guilford, Cumberland, Harnett and Wayne counties have been mentioned as potential landing spaces for up to 2,300 state jobs.

The state, or more specifically Republican legislative leadership, can’t open a bidding war between counties — “incentives” is the technical term — but they can float something else: a wink-wink, nudge-nudge deal.

Vote to override the budget veto and maybe the Department of Health and Human Services finds its way to your backyard. “But we know for a fact that they are shopping the move … to various counties in order to get votes to override the veto,” Cooper said last week.

The Republican leadership in the state House took a pass again Monday on voting on the veto override.

Health care for up to 600,000 North Carolinians and thousands of state jobs — the kind that don’t vanish once incentives are paid out — are caught in the brinksmanship over the state budget.

You were expecting something different?

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

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