“Healthy NC” or “Welfare State”?

The Medicaid debate in North Carolina is a battle between two big political figures, two big ideas and two big bets on the 2020 election.

Governor Roy Cooper believes that Medicaid expansion will mean a healthier North Carolina. Senate President Pro Tem Phil Berger believes expansion will cripple the state’s financial health.

Both men believe so strongly they’re right – about the policy and the politics of the issue – that they’ve let North Carolina go without a budget for over two months. And they appear willing to bet the 2020 election on it.

Cooper’s mantra is that he wants North Carolinians to be “healthier, better educated and have more money in their pockets.” He says Medicaid expansion will provide health insurance for 600,000 North Carolinians, the “vast majority” of whom work but don’t get insurance from their employers and can’t afford to buy coverage. He says expansion will rescue ailing rural hospitals and create new jobs.

Senate Berger wrote in an op-ed, “A full accounting of the facts leads to the inescapable conclusion that expanding Medicaid would be a mistake that not only will fail to solve the problems its proponents claim it solves, but will create new problems and rekindle problems that have just recently been put to rest – such as Medicaid cost overruns and yearly budget deficits.”

Governor Cooper believes expansion is politically popular. Democrats say Republicans are callous, putting ideology over people.

Senator Berger believes Republicans can tag Cooper and Democratic legislative candidates in 2020 as socialists, big spenders and big-government liberals.

The Governor’s allies say he’s dug in. He ran on the issue in 2016. It’s one issue that every Democratic legislator supports. Expansion supporters say 37 states have done it, including Republican states, and it has an extraordinarily positive impact on health care and people’s lives.

A study by the Urban Institute says expanding Medicaid has helped states combat the opioid epidemic.

Senator Berger’s allies, especially at the John Locke Foundation, have hammered Cooper over the issue.

The Foundation’s John Hood wrote that Republicans “don’t think the welfare state should get larger, making more people dependent on government handouts and moving our government further away from its limited, constitutional role in a free society.”

He argued that pushing Medicaid expansion would hurt Governor Cooper in polls, because voters won’t support “such a vast expansion of the welfare state.”

Well, if you pose the question that way, voters certainly won’t support it. But Cooper’s team poses the issue a different way. They say polls show that 60-plus percent of North Carolina voters support “health care for people who don’t have it.”

That’s what politics is about: Who frames the issue? One thing I’ve learned over the years is that Governors, like Presidents, have a communications advantage over legislative bodies.

Governors usually have a big edge in favorability and job-approval ratings over legislators. Cooper does.

Governors always have a bigger microphone to reach the public. Unlike the legislature, a governor speaks with one voice.

Governor Cooper is betting that Senator Berger and the Republicans eventually will negotiate. After all, House Republicans floated a form of Medicaid expansion by another name.

If Republicans don’t negotiate, the Governor and his team appear happy to take the issue to the voters next year.

Republicans and Democrats agree on one thing: Voters will have a clear choice.

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