Senate President Pro-tem Phil Berger has insisted that Medicaid expansion is not an option in North Carolina. It’s an ideological viewpoint that leaves some of the state’s working poor without adequate access to health care. It also disproportionally hurts the rural counties that make up the core of GOP support. 

Now, there’s dissention on the ranks. The Graham County Board of Commissioners, a body made up of four Republican and one Democrat, sent Burger a letter asking him to allow Medicaid expansion. The letter said, “…the majority of uninsured individuals in North Carolina are employed but do not make enough money to afford health insurance coverage.” While Berger is in Raleigh taking an ideological stand, the commissioners are dealing with the reality on the ground. People in poor rural counties are hurting and the GOP is turning their backs on them.

In an interesting reference, the chair of the Graham commissioners says, “We don’t have the luxury of doing things based on some national political party’s stance on some issue.” The phrasing echoes North Carolina Democrats from the 1980s. While Republicans were winning elections across the country, North Carolina Democrats held control by taking moderate approaches and breaking with national Democrats on more liberal issues. In 1984, poor Walter Mondale arrived in the state and nobody prominent showed up to greet the Democratic nominee for president.

Republicans hoping to win in 2020 should start eying that approach. Thom Tillis might think it’s good politics to wrap himself around Donald Trump, but constituents who are suffering because of Republican policies might not. Denying people health insurance has consistently been a political loser, even if bashing Obamacare briefly won Republicans elections before the program took effect. Killing jobs because of a needless trade war might give Trump a reason to thump is chest, but the folks reliant on the GOP’s skinny unemployment program might have second thoughts about voting Republican next year. 

We may be seeing the first substantial cracks in the GOP’s rural firewall. Their policies disproportionally hurt economically disadvantaged areas. It might be dawning on voters that the biggest threats to their well-being are the policies pass by Republicans, not the immigrants moving into their communities.  


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