Making Politics Work for Us: Medicaid expansion reaches rural North Carolina

Politics can often feel like someone else’s world, something that happens far away in Raleigh or Washington, DC. But what if we told you that when working-class people work together, we can pull politics down to our level –  and make politics work for us?
Courtney from Granville County fought hard for Medicaid Expansion. Here she presents to her chapter about how Granville County needs to help enroll eligible residents into the program.

That’s what happened last year when a decade-long fight for Medicaid expansion was won here in North Carolina. It was working folks like you who secured that win through relentless organizing. We grabbed “politics” away from big business and the wealthy few and made it ours. And now our communities are seeing the results in our day-to-day lives.

Medicaid expansion went into effect on December 1st, opening up access to health coverage for the 600,000 North Carolinians. “These are people who were in the Medicaid gap up until now,” explains Kate Daley, Down Home’s Health Justice Campaigner, “meaning that they were not able to afford health insurance, but their income was still too high to receive Medicaid.” Since December, over 350,000 of those people have now signed up for Medicaid expansion and have coverage. 

That’s over 350,000 people who can go to the doctor today who, two short months ago, didn’t have that choice. That’s a real working-class win. 

Medicaid expansion is not only having this very real impact on those 350,000 people– it’s also helping our rural communities. For years, our small towns have been losing health care providers and hospitals have even been closing due to the General Assembly’s refusal to expand Medicaid. Now that so many more people have coverage in our small towns, healthcare providers can keep their doors open.

The next hurdle is to make sure people know how to enroll and get the health coverage they qualify for and need. Down Home is hosting education and enrollment events across the state to help spread the word and get people the help they need. Some rural counties, such as Edgecombe and Robeson–where 12% and 13% of adults in the county have enrolled – are making strong efforts to make sure this resource is available to local families. Other counties, like Watauga and Granville, lag behind with less than 4% of the population with the information they need to get the coverage they qualify for. 

We find ourselves asking: What will it take to get the word out in these places? How can we hold our elected leaders accountable to this?

Expanding Medicaid is a huge win, but it’s not and never was our end goal. We strategically used Medicaid as a foundation off which we can build. We won Medicaid expansion against all odds– proving to those in power and to ourselves that we are a real force to be reckoned with. 

We now know what we can do, and our Health Justice Working group is working to identify more places and spaces in which we can flex our kind of “politics”– the politics that help everyday people in real ways.  

“We’ve heard from people in rural communities across the state about the challenges that affect them when it comes to health care, and there are several issues that seem to be felt across the board,” says Kate Daley. “Women’s reproductive health care is extremely limited in rural areas, and many counties do not have an OB GYN office or a labor and delivery unit. And the political attacks on abortion access in NC are felt hardest in the rural areas of the state. Lack of specialists and even primary care providers who can accept Medicaid is an example of a discrepancy that affects rural communities in our state, that can be addressed at the local level through the creation of provider incentive programs and public/private partnerships.”

Down Home members have started a statewide Health Justice working group to address these issues through research and advocacy, and through local member-campaigns that will continue to center the needs and voices of our people. If you would like to become a part of that work, contact Kate Daley here. 

Down Home Granville members discuss how to make sure people in their county know about Medicaid expansion and get enrolled.