Gov. Roy Cooper prompted loud cheers, whoops and a standing ovation during his state of the state address on Monday evening when he mentioned Medicaid expansion.
The governor came to the General Assembly as part of a biannual tradition to provide lawmakers and the people of North Carolina his take on how best to approach the future.
In his fourth such address, with a little less than two years left in his second term as governor, Cooper told lawmakers that he thinks the state is poised for “once-in-a-generation opportunities.”
That includes stepping up efforts to extend broadband to the rural-most reaches of the state. He called for double-digit raises for teachers and enhanced funding for North Carolina’s children, from cradle to career.
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Cooper hearkened back to the past as he heralded the future.
“Time and again, overcoming adversity, our leaders had the foresight and the resolve to invest in new ideas that have revolutionized our state, impacting the generations that followed,” Cooper said. “And while we stand on their shoulders, we also stand at an altogether new crossroads.
“Our moment to build enduring prosperity is now,” Cooper added.
Part of that construction, for some 600,000 low-income residents in North Carolina, is something Cooper has been advocating for since he became governor in 2017. Just last week, after years of facing opposition from Republicans to his pitch to extend the subsidized health care benefit made possible through the Affordable Care Act, Senate leader Phil Berger (R-Eden) and House speaker Tim Moore (R-Kings Mountain) made a long-awaited announcement: They had negotiated an agreement that would include a provision to expand Medicaid in the budget for the next two years.
Federal dollars at risk
Cooper reveled in the whoops and applause at his mention of Medicaid and the news from the previous week.
“I’m grateful for our unified Democratic legislators — and some of the Republicans who have been relentless for years in this effort to expand Medicaid,” Cooper said, acknowledging those across the aisle who had joined Democrats to make it happen.
“I commend the hard work of this Republican legislature for embracing this and coming together in agreement,” he said.
He thanked advocates who shared his commitment to making health care more affordable and accessible to residents who were caught between a rock and a hard place.
Expansion will cover many low-income workers who made too much money to get traditional Medicaid but didn’t earn enough for private insurance and could not get subsidies offered through the Affordable Care Act.
“When we get Medicaid expansion across the finish line, it will save lives,” Cooper said. “Tonight I bring a message of urgency that I hope all of you will keep at heart as we go through these legislative weeks.”
By tying Medicaid expansion to approval of the budget, the Republican leadership puts Cooper in a difficult position. If the lawmakers pad their spending plan with policies and budget items the governor is loath to support, he will be less likely to veto it and jeopardize the Medicaid expansion bill that only will be enacted once the budget passes.
“Every month we wait to expand not only costs lives but costs our state more than $521 million a month in federal health care dollars,” Cooper said. “If we don’t expand soon, we will forfeit an additional $1.8 billion in Health Care Access and Stabilization, or HASP funds, that our hospitals never will get back. That would be particularly hard on our rural hospitals. No business would make that kind of financial decision.”
The hospitals can claim retroactive HASP funding to cover care already delivered back to mid-2022 if the Medicaid expansion bill passes before the end of the state fiscal year on June 30.
“Guys, finally, we now all agree on Medicaid expansion,” Cooper added. “We now all agree on how to do it, and we all now agree on what other health care laws will be changed with it.
“For mental health, for working families, for rural hospitals, for a healthier North Carolina, for $1.8 billion that we cannot afford to leave behind, let’s expand Medicaid now,” Cooper said loudly.
Mental health projects
Many of Cooper’s special guests embodied some of the health care issues facing the state.
The COVID-19 pandemic exacerbated a mental health crisis already in the making. Many children and young adults are reporting depression, anxiety and other behavioral health concerns.
Meredith Draughn, a school counselor at B. Everett Jordan Elementary School in Alamance County and the National School Counselor of the Year, sees the problem firsthand.
“Her support is critical to their well-being and can be life-saving,” Cooper said, pointing to Draughn, who was sitting in the gallery of the House of Representatives. “All our counselors, teachers and school staff play a vital role in student mental health.”
Cooper said he already has directed “tens of millions of dollars” in federal funds to Mental Health First Aid that helps teachers and school staff recognize the signs of a child in crisis and other efforts. The governor hinted at more resources to come.
“I’ll propose a plan that makes historic investments in the whole-person health of every North Carolinian,” Cooper said. “It will save lives, save government resources and pay dividends for decades to come.”
Telecommuting to the doctor
Cooper singled out Kim Schwartz, CEO of Roanoke Chowan Community Health Center, and Phyliss Pillmon, an Ahoskie resident, to show how extending broadband can play a key role in telemedicine and providing better health care to residents in rural North Carolina.
“Phyllis has a hybrid plan of care, where she sees her regular doctor in person while connecting with specialists as far away as Charlotte,” Cooper said. “That’s a 280-mile gap that Phyllis and her specialist can span in just seconds.”
Additionally, Cooper called attention to Russell Devane, an Ivanhoe resident, who worked with the state to repair aging pipes and an inadequate system with a $13.2 million investment in a modern water and sanitation system that now delivers clean water to the Sampson County community.
Guns and children
Cooper also highlighted gun violence in North Carolina and the state’s place on a list that does not instill pride.
“A recent report found that in 2021, children in North Carolina were 51 percent more likely to die from gun violence than children in the U.S. as a whole,” Cooper said, referring to a recent report from the Child Fatality Task Force.
This legislative session, Republican lawmakers considered bills to end requirements that handgun buyers first obtain a permit from their county sheriff. Republicans advocating for the change have argued that it is not necessary because handgun buyers already go through a background check to purchase their guns.
Critics argue that not all purchases require such checks, while advocates point to research that shows the checks save lives.
“If you support the responsible gun ownership that we are granted under the Second Amendment as I do, then we cannot accept this,” Cooper said. “In the weeks to come, let’s move forward to fight gun violence, not backward.”
Cooper acknowledged the differences that he and the Republican-led General Assembly have had over the years.
“In my six years as Governor, you legislators and I have found plenty to disagree about,” Cooper said. “But we have found areas of common ground to strengthen our communities, create opportunity and make our state more resilient and prepared for the future.”
“This has always been North Carolina’s story: good people from diverse communities coming together to build a common future.”