The budget is not even out and two major legislative fights are already brewing. The first is the governor’s proposal to privatize Medicaid and the second is Rep. Skip Stam’s proposal to use school vouchers. The success of both measures depend on the willingness of rural legislators to put ideology before the interests of their constituents.
In the Medicaid fight, doctors with deep pockets, allied with the public health advocates, are already lining up against the governor’s proposal. They’ve worked closely with the current system to control costs and expand access and, unlike many states, “the vast majority accept Medicaid patients.” In poorer, rural areas, Medicaid is a major source of revenue for doctors who choose to live and practice there.
McCrory’s plan would outsource services to managed-care corporations, possibly cutting off vital streams of revenue for the rural doctors. In some counties, clinics might close and doctors might leave for areas less dependent on Medicaid. Legislators might find themselves trying to explain to their constituents why they have to change doctors and drive to other counties for services.
In the voucher fight, the battered teacher’s organizations will go to the mat to oppose a program that sucks money from public schools and puts it into private ones. According to Stam’s bill, the state would subsidize families making up to $70,000 a year to send their children to private schools. Most of this money would go to urban and suburban areas where private schools are located. In this case, rural legislators will have to explain to their constituents why they supported shifting money from struggling local public schools to private ones in the cities.
Both Medicaid privatization and school voucher programs are more about ideology than practicality. Few professional relationships are more personal than the one between doctor and patient. Few community relationships are more shared than the one between families and schools. In rural areas already rocked by economic changes, are legislators really willing to risk chasing doctors away and shipping education money to private schools? If they are, the next change might be in the make-up of the legislature.