By skyforbes 
North Carolina’s Medicaid Expansion win shows us what we can do.
I spent my early twenties around campfires, dreaming up utopias with my friends. We read theory, debated politics, and tried on philosophies for size. Those were important days, vital times, and I wouldn’t trade them for a thing.
But by my mid-twenties, I was a single mom hustling jobs, balancing bills, and falling asleep every time I even attempted to open a book to read. The dreaming didn’t stop, but ideological stands quickly took a backseat to the practical needs of everyday life.
That is where most of us live– deeply immersed in a day-to-day so carefully balanced between work, family, children, and community that we don’t have much bandwidth to spare. We are navigating high rents and corporate landlords; childcare costs that eat up half our wages; prescriptions that are more than we can possibly make. We have real needs, practical and down-to-earth desires– things that we need solutions to today, not tomorrow.
That is why working-class North Carolinians waged a long, determined crusade to expand Medicaid in our state — and that is also why they won. Being tied down in a daily grind doesn’t mean we become apathetic, but the opposite: We become determined and resolved. Today, Medicaid Expansion will go into effect, allowing more than 600,000 of our neighbors to finally access healthcare. It turns out that needing something practical like healthcare can cause people to wage a hell of a fight.
The need was so big, the idea so plainly sensible, North Carolinians across the state suspended their ideologies and transcended party politics to support Medicaid expansion. Earlier this year, a poll found that 78 percent of North Carolina voters supported it. This included 96 percent of Democrats, 71 percent of unaffiliated voters, and 64 percent of Republicans as well (ACS CAN, 2023).
Why with this overwhelming public mandate did it take over 10 years to pass Medicaid expansion here? Because some politicians in Raleigh were unable to suspend their ideologies to do the thing we needed. They preached against “big government” and the “nanny state” while the rest of us just wanted to go to the doctor. Perhaps less impacted by the harsh day-to-day the rest of us experience, they weren’t driven by necessity and need. Instead, they spent their time performing perfectly principled politics while North Carolinians suffered and even died.
There were of course some elected officials who suspended their ideologies and read the room: Republican Donny Lambeth, a former hospital administrator, kept the conversation about Medicaid Expansion alive for years against his party’s wishes and, often, against all odds. Republican Ralph Hise did as well because he was keeping his ear to the ground in rural communities and saw the need firsthand. Democrats across the board were far more supportive of Medicaid Expansion, but it was those with lived experience and close community connections like Diamond Staton-Williams, who is a nurse, and Royce Cooper who led the charge.
Eventually, the overwhelming need for and practicality of Medicaid expansion superseded political purism, and even the most stalwart Republican holdouts gave in. In the end, there was no philosophy or political theory that could continue to rationalize letting so many North Carolinians languish in the coverage gap– organizers and working-class advocates made sure this much was clear. Last spring, Medicaid Expansion passed and Governor Cooper was finally able to sign it into law.
Still, there were holdouts. The most notable objector was Lt. Governor Mark Robinson. Even as his own party began to see the necessity of expansion, Robinson said “I hope that it fails” (Business North Carolina, 2022) and, to this day, opposes healthcare coverage for those families.
Robinson is running to replace Cooper as Governor and often talks about his working-class credentials. How is it that he so quickly has forgotten the day-to-day practical world that most of us live in to favor such rigid political purism? Denying your neighbors’ healthcare is a strange thing on which to hang your ideological hat.
Thankfully, Robinson’s party ignored his objections and moved in step with North Carolina. In a year where the NCGA has seemed more keen on pushing abstract culture war politics than passing real, working-class policy, Medicaid Expansion was, remarkably, achieved. Today, those 600,000 people can apply for Medicaid– and tomorrow they can make a long overdue appointment.
I am still a dreamer and, especially on Friday night over a few beers, a bit of an ideologue — I suspect we all are. But most of us can and will gravitate towards actionable solutions over principled party politics. We don’t elect people to orate and grandstand; we elect them to pass policy to make our lives better. That’s what North Carolinians asked for when we asked for Medicaid Expansion: It wasn’t glamorous, it wasn’t pie in the sky, it wasn’t utopian or filled with buzz words,it wasn’t good fodder for shock jocks– it was just heartbreakingly necessary and real.
Hopefully, next time we have a need we won’t have to fight our “principled” leaders for ten years.