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The news gathering business is not what it used to be. That is especially true in local communities where there is a lack of investigative reporting to hold the powerful accountable, to record history, to celebrate and to inform. Bill Kovach and Tom Rosenstiel in The Elements of Journalism, tells us that journalism “is not defined by technology, nor by journalists or the techniques they employ.” Rather, “the principles and purpose of journalism are defined by something more basic: the function news plays in the lives of people.” Unfortunately, newspapers in particular have been on a downward spiral for more than 40 years. Meanwhile, digital news sources are on the upswing, as people are using their mobile devices to stay informed of breaking news alerts. The breaking news alerts have value, but they don’t replace the in-depth investigative reporting that provides the type of coverage needed to keep the general population informed. Fortunately in North Carolina a handful of online investigative news sources, such as The Assembly, Carolina Public Press and Asheville Watchdog, are working to fill the void. It’s no secret that technology and lifestyle changes contributed to the consistent decline of traditional newspapers, a decline that impacts democracy in the United States and North Carolina. News organizations such as the New York Times, Washington Post, the Wall Street Journal and national cable news networks such as CNN, Fox News, and MSNBC continue to provide in-depth national and international coverage. However, they are not providing the in-depth coverage needed at state houses, including the North Carolina Legislature. An initiative called Press Forward, coordinated by the MacArthur Foundation in cooperation with 20 nonprofit organizations plans to invest $500 million over the next five years in local media organizations. That is a significant infusion of dollars to address the predicament of local news. The initiative will invest in nonpartisan efforts to provide access to news that is important to residents and voters. It is crucial that news organizations hold elected officials accountable for their policymaking. A case in point is House Bill 259, the appropriations bill that funds state agencies, departments and institutions, that became law in October 2023. The Republican-controlled legislature inserted language into the bill that gives them the authority to appoint special Superior Court Judges to eight-year terms without oversight and exempts them from the state public records law, allowing them withhold their documents from public view. They also inserted language that empowers the Joint Legislative Commission on Governmental Operations, or GovOps, to investigate state and local government agencies, as well as private companies and charities that received taxpayer funding. Public employees contacted by investigators would be required to keep those communications and requests for information confidential. One Democratic lawmaker compared the new powers to setting up a new government “Gestapo,” a comparison to Nazi Germany. There will be severe penalties for not cooperating with an investigation, which could cost jobs and result in criminal charges. The role of newspapers and other media is to shed light on this type of legislation by keeping the public informed. While some state news organizations covered these add-ons to the budget bill, local news outlets don’t have the staff or resources to provide their readers with adequate coverage of the legislature and how the laws they pass affect them. The decline of newspaper readership gives legislators and government officials the freedom to enact legislation that is often not in the best interest of the public. Rather it is in the best interest of the politicians and their desire to remain in power and control the state for their political party. This has been clear with gerrymandering, a strategy that disenfranchises voters, and with the attack on public education, with the push for more charter and private schools. Voters have to do their own due diligence to find out the potential impact of laws passed by state lawmakers . Unfortunately, they cannot count on newspapers, as times have changed forever. The investment by the MacArthur Foundation and other foundations is an important step in reshaping the news and information landscape. Here are other strategies voters can utilize: 1. Follow reliable online news sources: While traditional newspapers may be declining, there are still many reliable online news sources available. Readers can follow reputable news websites. 2. Check the legislature's website: The North Carolina General Assembly's website provides access to bills, committee meetings, and other information related to the legislative process. Readers can check the website to find out what is happening in the legislature. 3. Follow legislators' social media: Legislators often post updates and information on their social media accounts. By following their accounts, readers can stay informed about their actions and positions. 4. Attend public hearings: The legislature holds public hearings on bills, and attending these hearings provides an opportunity to learn more about proposed legislation and provide input. Readers can find information on hearings by checking the legislature's website or contacting their representatives. 5. Engage with advocacy groups: There are many advocacy groups working to hold legislators accountable and promote transparency in government. Readers can engage with these groups to stay informed and get involved in advocacy efforts. Stay informed to make sure legislators serve their constituents’ interest, not their own. If not, use the power of the ballot box to replace them. Virgil L. Smith formerly served as president and publisher of the Asheville Citizen-Times and Vice President for Human Resources for the Gannett Company. He is the principal for the Smith Edwards Group and the author of "The Keys to Effective Leadership.” He is the founder and a writer for Carolina Commentary.

North Carolina’s hit parade of voter suppression marches on, now that the GOP has overridden Gov. Roy Cooper’s veto of Senate Bill 749, with tight ballot-receipt deadlines and extra signature scrutiny for mail-in voting, plus extra identification for same-day registrants. Both rules especially affect people of color and young voters who register on voting day and vote by mail at higher rates. Maybe politicians who become legislators don’t want deliberate debate and democratically-determined decisions. Or maybe even actual democracy. Rather than an election-day postmark, ballots must be received by poll-closing, which could invalidate many votes, due to delivery variation. New rules about same-day registration—extra identification and throwing away ballots of registrants whose mail comes back as undeliverable—make it harder to register during an early voting period. These rules especially affect the young and people of color. Tight turnarounds for mail-in voting make no sense, when there’s little to no evidence of electoral fraud. The practice dates from the Civil War, but Republicans seem to think it’s a scam, a partisan ploy designed to steal their votes. But even before the 2020 election, during Covid, absentee voting was on the rise. The only scam afoot is the GOP’s systematic efforts to undermine democracy. Mail-in voting includes signature verification, drop boxes in safe locations, and address confirmation. A Washington Post analysis found few (0.0025 percent) possibly fraudulent votes in the 2016 and 2018 elections. And, according to The Hill, in 20 years and 250 million mail-in votes, there were 143 criminal convictions. Significantly, the law also shifts county and state election board appointments from the governor to legislators; House speaker, Senate leader, and minority party leaders in each chamber would each appoint two members, replacing the current five-to-three, governor-selected appointees. Such deadlocked,bi-partisan boards are a gridlock guarantee. Deadlocked boards are figuring as prominently in partisan politics as in corporations. Corporate deadlocked boards are designed to keep a CEO entrenched. What should we infer from the GOP’s political move? Maybe gridlock is the goal. Suppose members deadlock on election certification; if legislators are called to decide, the Republican majority rules. District maps, currently being re-drawn, may also be GOP-gerrymandered. Theoretically the new configuration could avoid partisan advantage, through healthy debate and compromise. In reality, the deadlock ensures tied votes on decisions, with legislators stepping in to make the call. Is that what we want? One-party rule? Republicans have veto-proof majorities as well as a N.C. Supreme Court majority of 5-2 after last year’s election. Compromise and democratic deliberation seem forgotten and forsaken; certainly they seem like pre-Trump notions. Maybe some legislators have forgotten such skills and why they matter to voters. Or, maybe politicians who become legislators don’t want deliberate debate and democratically-determined decisions. Or maybe even actual democracy. Betty Joyce Nash reported for the Greensboro News & Record and the Hendersonville Times-News before moving to Virginia where she worked as an economics writer for the Federal Reserve Bank of Richmond. She co-edited Lock & Load: Armed Fiction, an anthology of literary short stories that probe Americans' complicated relationship to firearms. (University of New Mexico Press, 2017.)

On Aug. 28, Muhsin Mahmud, an exchange student from the UK, was making a video as he walked through the idyllic campus of my alma mater, the University of North Carolina. “You can have a little picnic here,” he said, panning around to show the tall trees and crisscrossed sidewalks with students leisurely walking to class. That was the ironic moment when air raid style sirens abruptly began blaring throughout Chapel Hill, shattering the peace. “I have no idea what the hell that is,” Mahmud said right before loud speakers announced an "armed, dangerous person." That was also the moment my daughter, a current student, called me. We were on a video call for two hours as we both sifted through online rumors about what was going on. The lockdown continued for an hour more as police methodically ruled out the possibility of a mass shooting like the one that occurred at our sister school, UNC-Charlotte. Thankfully, the terrifying incident turned out to be “only” a single murder. Outside North Carolina, it didn’t even get a lot of news coverage since it didn’t qualify as a mass shooting event. That changed, however, on Aug. 30 when The Daily Tar Heel — the student run newspaper published every Wednesday — appeared in newsstands. Instead of the football edition the editorial staff had already completed, the front page of the paper was covered with bold black and red text messages that students had exchanged during lockdown: HEY — COME ON SWEETHEART — I NEED TO HEAR FROM YOU. CAN YOU HEAR ANY GUNSHOTS? I’M IN CLASS EVERYONE IS LOSING IT PEOPLE ARE LITERALLY SHAKING. GUYS I’M SO FUCKING SCARED. The front page was such an authentic encapsulation of the moment that it immediately went viral. That evening President Biden posted an image of his hand holding his cell phone as he read the page. In the coming days, the young editors were being interviewed by NPR, NBC and other national press. As my own social media filled up with posts and reposts of the page, most parents and other adults were supportive, proud, and frankly in awe of what these student journalists had accomplished; however, a small but vocal minority had perplexing reactions like these: “Please remove this post…it contains foul language and just needs to be deleted.” “This language is inappropriate. Take it down or blur the words." “This post needs to come down because of the language.” That group of adults was more outraged by F-bombs being used in college students’ texts than they were by a gun being used to commit murder and spread terror throughout the UNC campus. I think it’s important to note that these people weren’t online trolls whose purpose is to bait people into reacting emotionally. They were real people who probably believed they were being virtuous. I imagine many of them were earnest conservative Christians speaking out for their values. I am an unaffiliated voter, part of the largest voting group in the state. While I tend to vote Democratic, I have voted for multiple Republicans and have been satisfied with several Republican officials I’ve known over the years. However, I doubt I will vote for a Republican in a partisan race for at least ten years, and the reason is related to the “outrage” reactions I witnessed on social media after the shooting. I’ve been watching closely and from what I see, the Republican Party is no longer interested in governing or solving problems or doing anything constructive. They don’t think it’s the government’s role to provide a safety net for the vulnerable or to ensure communities have safe water or to provide public education for all children. The only thing they seem to care about is the outrage of the week, which often makes no sense to anybody else. So instead of talking about ways to prevent terrorist-style events from happening on our college campuses, they were talking about how offended they were by strong language. Other things they are outraged about? Books with same-sex parents. (Not my family’s values!) The separation of church and state. (There should be prayer in school!) And anything they label as woke. (Removing Confederate statues! The anti-patriarchy of the Barbie movie! The footwear on the Green M&M!) It is ridiculous. It’s ridiculous but it’s also terrifying. The flash-in-the-pan outrage parade serves to manipulate a large voting bloc of evangelical Christians who strive to put their faith first. I believe these people are sincere and well-intentioned, but from my perspective, in recent years the vast majority tend to support any politician who makes a lot of noise about Christian values, even as that person is advocating legislation that harms Americans, the Earth we share, and global stability and often behaving in most un-Christian ways. From what I was taught growing up in a Southern Baptist church, many of the actual policies pushed by these extremely religious-sounding politicians directly oppose the foundational teachings of Christ. Also, from what I see, these leaders are exclusively Republicans. My parents were Republicans and I have been an engaged voter for more than 40 years. I feel confident in saying the Republican Party of the past does not exist today. I find this upsetting because I believe a healthy two-party system in which ideas can be debated is important, but I know we can’t pretend that today’s Republicans are working to create anything other than chaos to achieve an authoritarian right-wing state in which they control everything and everybody. It is not hyperbole to say they are following a fascist playbook. The outrage of the week is fundamental to their effort. The outrage of the week is the Pied Piper of the radical right-wing movement, causing a huge voting bloc of people to elect legislators who will make drag shows illegal but not child marriage, who argue that a microscopic embryo has more rights than a ten-year-old rape victim, who will deliberately make it more difficult for people of color to vote, who will criticize college students’ text messages rather than challenge the gun lobby. To have a choice in future elections we have to defeat authoritarians who have co-opted the Republican label. I’m asking other unaffiliated voters to re-examine the idea that we currently have two legitimate parties to choose from. I’m asking them to think about joining a coalition of people — including many former leaders in the Republican party (Stuart Stevens, Jennifer Rubin, Steve Schmidt, Justice Michael Luttig, Tom Nichols, Nicolle Wallace, Christine Todd Whitman, and many others) — in voting Blue. From my perspective, the faster we elect Democrats in a landslide, the faster we can put guardrails back in place (such as passing the Voting Rights Act) and the faster we can rebuild a two-party system that reflects the will of the people. I am cautiously optimistic. I have to believe that most Americans are in favor of limiting the proliferation of AK-15s in our communities. I have to believe that most people support our public education system. I have to believe that most people want voting to be accessible for all eligible Americans. I have to believe that most people will come to see beyond the outrage of the week and realize we have to address issues that affect people’s lives rather than made-up offenses. Elizabeth Gibson is a freelance writer who learned to meet deadline using black manual typewriters at the University of North Carolina at Chapel Hill. She has lived in the mountains of Western North Carolina for more than 30 years.

In early September, N.C. Superintendent of Schools Catherine Pruitt told the State Board of Education that school systems need more time to comply with the controversial Parents Bill of Rights that became law in August when the Republican-led legislature overrode Gov. Roy Cooper’s veto. The law requires educators to alert parents if their child changes his or her name or uses a different pronoun at school, restricts instruction about gender identity and sexuality in K-4 classrooms, requires parental consent for providing health care to children, requires parental permission to opt into surveys that ask questions about sexual behavior, illegal activity or mental health issues and requires school systems to more fully inform parents about how to object to materials or curriculum topics. Except for the provision about providing health care, which doesn’t kick in until Dec. 1, the law went into effect Aug. 15, days before school started on Aug. 28. Developing policies and procedures to comply will take hours of meetings and significant resources at a time when many school systems are still trying to find teachers to fill vacancies. If this were a law that promised to better prepare North Carolina students to navigate a world where those with nimble discernment and critical thinking skills will be best positioned to thrive, implementing it would be a good investment of time and resources. But, to the contrary, it’s a law that’s unnecessary, intrusive, likely disruptive and potentially harmful. It’s hard to see how this law furthers the primary function of public schools, which is to educate students and provide them with the skills they need to be contributing members of society. It’s even harder to think of a praise-worthy reason GOP lawmakers would spend the 2023 session, which began in January, hashing out divisive bills like this one and another one that denies treatment to young people with gender dysphoria, when they couldn’t be bothered to pass a 2023-2024 budget, the most fundamental thing their constituents send them to Raleigh to do. There can be little doubt, both these laws are an attempt to marginalize a very small number of vulnerable young people. Tamika Walker-Kelly, president of the NC Association of Educators, the state’s largest teachers’ group, told WRAL news in Raleigh that teachers are most concerned with the effect the new Parents Bill of Rights law will have on LGBTQ+ students and families, especially the provision that requires schools to inform parents if a student is questioning their own gender. “We know that not every student who comes to us at school has a caring adult, and sometimes the educator or the school personnel is that caring adult for that student,” she said. “It is our responsibility, part of our professional standards and code of ethics, to think about first the priority of the student, their health and safety. We will continue to navigate that as educators, but this provision in the law does make that a lot more difficult.” In the fall of 2022, the news agency Reuters worked with the health technology company Komodo Health Inc. to identify the number of young people, ages 6 to 17, in the United States who sought and received gender-affirming care between 2017 and 2021. Komodo’s analysis draws on full or partial health insurance claims for about 330 million U.S. patients, including those covered by private health plans and public insurance like Medicaid. The data included roughly 40 million patients annually between ages 6 and 17. In 2021, the total number of young people diagnosed and/or treated for gender dysphoria, which is defined as distress caused by a discrepancy between a person’s gender identity and the one assigned to them at birth, was about 42,000. The total U.S. number over the five-year period was 121,882. Putting that into context, during the 2020-2021 school year, approximately 1.6 million students attended North Carolina public and charter schools. North Carolina makes up about 3.2 percent of the total U.S. population of about 340 million. That means there are likely less than 1,500 students in the entire state of North Carolina, where there are 2,500-plus public schools, who experience gender dysphoria. Why would state lawmakers spend time targeting such a small and vulnerable number of students instead of passing a budget that will hopefully give the state’s poorly paid teachers a raise? It is especially concerning given the evidence that youth who suffer from gender dysphoria are at high risk of severe depression and suicide. A study published by the Journal of the American Medical Association found that receipt of gender-affirming care in one small cohort of transgender and nonbinary youth was associated with 60 percent lower odds of moderate or severe depression and 73 percent lower odds of suicidality over a 12-month follow-up. There can be little doubt that decreased social support and increased stigma likely to result from legislators meddling in very private matters will almost certainly lead to increased mental health problems for this small group of young people. Meanwhile the calendar rolled toward mid-September with the state’s citizens still waiting for a budget that should’ve been passed with the start of the fiscal year July 1. Will teachers get a hefty raise? Will per pupil funding for schools increase significantly to give them the resources they need to prepare North Carolina students to navigate a world of evolving technology? A report published by the Education Law Center found that per-pupil funding in North Carolina ranked lower than any other state, when compared to the state’s wealth. In terms of total funding per pupil, the state fell from 46th in 2008 to 48th in 2020, according to the report. Will these metrics change as a result of the 2023-2024 budget? If not, it’s pretty clear that GOP lawmakers think fighting a manufactured culture war against a small vulnerable group of young people is more important than providing an adequate education for the state’s entire student population. Joy Franklin is a journalist and writer who served as editorial page editor of the Asheville Citizen-Times for 10 years. Prior to that she served as executive editor of the Times-News in Hendersonville, N.C. Franklin writes for Carolina Commentary

The Supreme Court of the United States is quickly changing the culture and rule of law for future generations. Historically, justices have been nominated and approved to honor and interpret the Constitution to make fair decisions that impact American society. Given their lifetime appointments, justices affect American life more than Congress or the Executive Branch, led by the president. As we all know, the decisions made by Supreme Court justices set precedent; the court has made historical decisions that have changed the direction of the nation. Some of the more influential Supreme Court cases were decided this year. Democracy prevailed in two decisions. In Allen v. Milligan, five justices, including Chief Justice John Roberts, agreed that Alabama’s gerrymandered congressional maps must be redrawn. And in Moore v. Harper, which originated in North Carolina, the court rejected the “theory” that the Constitution gives legislatures power over federal elections with no checks and balances from state constitutions, courts, governors, or voters. But the Court also repealed Roe vs. Wade, the law of the land for the past fifty years. The justices took away a woman’s right to decide the fate of her pregnancy and delegated states the power to determine abortion laws, to the detriment of women. Also, the Court overturned affirmative action for college admissions, causing deep concern in communities of color, especially the African-American community. Many have benefited from affirmative action, and may not have been accepted into colleges such as Harvard and the University of North Carolina without the decision. But this court found affirmative action in violation of the equal protection clause of the 14th Amendment. Supreme Court Justice Clarence Thomas attended Yale Law School, but voted against affirmative action. He had previously told employees at the Equal Employment Opportunity Commission: “God only knows where I would be today,” if not for the legal principles of equal employment opportunity measures such as affirmative action that are “critical to minorities and women in this society.” My, my how things have changed from Justice Thomas’s decades-old quote to the present, when he voted to eliminate and close the door on affirmative action for many students of color. All is not lost because historically Black colleges and universities stand to benefit from students who are seeking a college education. Justice Thomas stated: “Our Constitution is colorblind, and neither knows nor tolerates classes among citizens.” Unfortunately, we do not live in a colorblind society in America. Race and skin color still matter, given the United States’ history of slavery that has strongly influenced the generational wealth, or non-wealth, for white and Black families. When Supreme Court Justices are nominated and affirmed based on their ideological and political affiliations, all Americans lose. The conservative appointments by then-President Donald Trump illustrate the point. Supreme Court justices serve for life. Recent appointments of youthful justices, Neil Gorsuch, Brett Kavanaugh and Amy Coney Barrett mean that all could serve for the next 40 years. The conservative justices have demonstrated their commitment to a conservative ideology that will shape life for Americans for years to come. As President Obama once said, “elections have consequences.” Senator Mitch McConnell, a Republican, understood this when he blocked Obama’s Supreme Court nominee, District Court Judge Merrick Garland, with an unprecedented act denying Judge Garland a Senate hearing. McConnell subverted the will of the people, who elected Obama, to prevent the appointment of a Supreme Court justice he did not consider to be ideololigically aligned with his own party. It matters who nominates the Supreme Court justices in the United States. The Justices will rule our lives for generations. The decision on race-based criteria for college admission affects people of color, and benefits white college students in legacy admissions, according to an Associated Press survey of the nation’s most selective colleges. The survey found that legacy students in the freshman class ranged from 4% to 23%. At four schools — Notre Dame, USC, Cornell and Dartmouth — legacy students outnumbered Black students. "Legacy preferences have become an easy target in the wake of a Supreme Court decision that hinged on questions of merit in the college application process. Instead of getting in on their own merit, legacy students are standing on their parents’ shoulders." said Julie Park. Park studies college admissions and racial equity at the University of Maryland. “Let’s be clear: affirmative action still exists for white people. It’s called legacy admissions,” Rep. Barbara Lee, a California Democrat, said on Twitter. If a case challenging legacy admission makes its way to the Supreme Court, will the court decide to maintain this form of affirmative action for primarily white students? In North Carolina, Duke University and UNC Chapel Hill have taken action in response to the U.S. Supreme Court Affirmative Action decision. Both schools will target students based on income criteria. However, there is pushback from some at UNC Chapel Hill and further discussion on the financial admissions policy. This is a proactive approach to providing an opportunity for students from lower income families a chance to change the direction of their life and that of their family. This strategy is not race based and does not award students of families that attended a particular school. Access to a quality education is a game changer for many college students. A college education is valued and impacts who gets ahead in our society. If we citizens of the United States want a nation that is less polarized, based on fairness and equity, we need to vote for representatives who place the good of the nation first, regardless of political affiliation or loyalty to a political party. We should elect presidents who will nominate and senators who will affirm Supreme Court justices who make decisions that, instead of reflecting political ideology, provide equal justice under the Constitution. Virgil L. Smith formerly served as president and publisher of the Asheville Citizen-Times and Vice President for Human Resources for the Gannett Company. He is the principal for the Smith Edwards Group and the author of "The Keys to Effective Leadership.” He is the founder and a writer for Carolina Commentary.

For someone living in a rural county like Rutherford where the name of the Republican candidate is the only one on the ballot in most local races, it’s not news that the state Democratic Party has been largely missing in action during the past several election cycles. At the state level in 2022, Republicans were unopposed by a Democrat in one-fourth of House and Senate races. Even though it wasn’t news, it was gratifying to hear a Democratic Party official acknowledge it, as Vice Chair Jonah Garson did during a recent event at Henderson County Democratic Party headquarters. Thankfully, the party shows promising signs of coming to life again. Garson filled in for N.C. Democratic Party Chair Anderson Clayton, who stayed in Raleigh to participate in demonstrations associated with Gov. Roy Cooper’s veto of legislation that will ban nearly all abortions in North Carolina after 12 weeks. The New York Times recently profiled Clayton who, at 25, is the youngest state party chair in the U.S. After a friend invited me to the event, I looked forward to hearing her speak. But in her stead, Garson didn’t disappoint. An energetic, enthusiastic and engaging speaker, he told the gathering that a reform-minded board took over state party leadership a few months ago and plans to recruit and support candidates in every N.C. county. That’s good news. Voters deserve a choice when it comes to governing philosophy. But at the local level, where voters often have more direct knowledge of candidates, being able to choose the more capable one, no matter party affiliation, in terms of temperament, knowledge of the community and record of service should arguably carry even more weight. When there’s no competition, even the most incompetent or temperamentally unsuitable candidate can prevail. Garson, 36, is a civil litigation attorney who worked in the N.C. General Assembly for the late Rep. Paul Luebke, a Greensboro Democrat, before attending law school. He acknowledged that Democrats face an uphill battle. He quickly summarized how Republican strategic planning helped the party gain control of state legislatures, including North Carolina’s, through project REDMAP, by pumping huge amounts of money into swing state races aided by the Citizens United decision that allowed corporations and labor unions unlimited spending in support of candidates. Republicans outmaneuvered Democrats at a time when advances in computer software make it possible to surgically draw district lines to their advantage. Now that the Republican majority on the state Supreme Court has reversed precedent and declared it has no role in determining whether district boundaries disenfranchise voters, you can bet the Republican majorities in both chambers will draw maps that virtually guarantee noncompetitive districts. But Garson said N.C.’s new Democratic Party board has a six-year strategy to turn things around with four major goals. The first is to elect a Democratic governor in 2024. The second is to break the Republican’s supermajority in at least one General Assembly body, making it possible to sustain a gubernatorial veto. The third focuses on the courts, with a goal of replacing retiring Justice Michael Morgan, a Democrat, with another Democrat, and winning a full term for Judge Allison Riggs on the Court of Appeals. Gov. Roy Cooper appointed Riggs to the appeals court in 2023 to fill a vacancy left by Republican Richard Dietz, who was elected to the N.C. Supreme Court in November. The fourth goal is to win North Carolina for Joe Biden in 2024. In addition to putting resources into recruiting candidates and urging candidates and volunteers to go out into the community to talk to voters about their concerns, the party plans to employ 12 to 13 regional directors whose job it will be to support local candidates and to make sure the insights they gain from that voter interaction are integrated at the state level. “In so many of these communities that we need to win, the state Democratic Party has been like wall flowers at a middle school dance, dickering over the line that’s going to get the person we want to dance with us out on the floor and not saying anything at all,” Garson said. “I think that as Democrats we have great values and great policy. Policy is a terrible pick-up line. We really need to start just by talking to folks and having some variation of ‘Hey, we’re are fighting for freedom for you to retire with security, for having a town that your kids want to stay in, for the future of this place, for public education, for safe water, for you to do what you want when it comes to having a family.’” There is no motto or slogan that will move people, he said. Garson’s point is well taken. Until local Democrats develop a coherent and authentic response to Republican messaging, there can be no real debate about the role of government in solving the problems that confront us. And without that, there can be no consensus, no common-sense middle ground. We need civil debate about issues, not harangues that demonize those with a different point of view. Republicans have claimed the mantle of the party of freedom, but Garson talked about N.C. Democrats adopting Biden’s campaign theme that Democrats are in fact the party of freedom – freedom to decide what to do with your body, freedom to be safe in public spaces, freedom to vote. A vigorous debate about what exactly it means to be free seems a good place to start. North Carolina needs a vibrant, energetic Democratic Party, one that’s peeled off the wall, found its voice and walked onto the dance floor. Joy Franklin is a journalist and writer who served as editorial page editor of the Asheville Citizen-Times for 10 years. Prior to that she served as executive editor of the Times-News in Hendersonville, N.C. Franklin writes for Carolina Commentary.

Reprint from Carolina Public Press and KFF Health News BAMBERG, S.C. — Years before the Bamberg County Hospital closed in 2012, and the next-closest hospital in neighboring Barnwell shut its doors in 2016, those facilities had stopped delivering babies. These days, there’s not even an ultrasound machine in this rural county 60 miles south of Columbia, much less an obstetrician. Pregnant women here are left with few options for care. Federally qualified health centers offer prenatal services in nearby Fairfax and Barnwell, but only when a pregnancy is uncomplicated and only through about 34 weeks of gestation. During the final weeks of pregnancy, women must transfer their care to the nearest obstetrician, often in Orangeburg, which can be 20 miles away or more, depending on where they live in Bamberg County. Some women travel farther to hospitals in Aiken or Beaufort, where health outcomes are better. “Most of our women are driving an hour or more from their homes to an OB provider,” said Tracy Golden, a doula and senior program manager for the South Carolina Office of Rural Health. Although the regional hospital in the city of Orangeburg delivers babies, the birth outcomes in the county are awful by any standard. In 2021, nearly 3% of all Black infants in Orangeburg County died before their 1st birthday. Nationally, the average is about 1% for Black infants and less than 0.5% for white infants. Meanwhile, Orangeburg County’s infant mortality rate for babies of all races is the highest in South Carolina, according to the latest data published by the South Carolina Department of Health and Environmental Control. By 2030, the federal government wants infant mortality to fall to 5 or fewer deaths per 1,000 live births. According to annual data compiled by the Centers for Disease Control and Prevention, 16 states have already met or surpassed that goal, including Nevada, New York, and California. But none of those states are in the South, where infant mortality is by far the highest in the country, with Mississippi’s rate of 8.12 deaths per 1,000 live births ranking worst. Even in those few Southern states where infant mortality rates are inching closer to the national average, the gap between death rates of Black and white babies is vast. In Florida and North Carolina, for example, the Black infant mortality rate is more than twice as high as it is for white babies. A new study published in JAMA found that over two decades Black people in the U.S. experienced more than 1.6 million excess deaths and 80 million years of life lost because of increased mortality risk relative to white Americans. The study also found that infants and older Black Americans bear the brunt of excess deaths and years lost. That makes Black infant mortality in the South a complex regional crisis that should alarm everyone, not just future parents, said Georgina Dukes-Harris, senior director for social care at Unite Us, a national technology company focused on societal needs. Birth outcomes for mothers and infants are a leading indicator of population well-being and they run much deeper than health care: They reflect politics. They’re a direct product of generational poverty and racism. They reveal our priorities, Dukes-Harris said. Often, babies die under circumstances that states, communities, and parents can help control, like making sure infants don’t suffocate in beds or in unsafe cribs, or extending health coverage so that young women can afford to see a doctor before they become pregnant. In many of these respects, the South is failing. “This is something that has to change,” Dukes-Harris said. ‘An urgent problem’ with no easy solution Public health officials are still trying to parse the long-term impact of the covid-19 pandemic, but infant death rates in South Carolina were higher than the national average long before the health care landscape changed in 2020. And a report published by the South Carolina Department of Health and Environmental Control in April shows the rate for non-Hispanic Black babies — who died at a rate nearly 2½ times that of non-Hispanic white infants in South Carolina in 2021 — is growing worse. The death rate among infants born to Black mothers in the state increased by nearly 40% from 2017 to 2021. “That’s just not acceptable,” said Edward Simmer, director of the South Carolina health department. “It’s absolutely an urgent problem to me.” It’s a problem, though, without an apparent solution. Multimillion-dollar programs to improve South Carolina’s numbers over the past decade have failed to move the needle. To make things more complicated, separate state agencies have reached different conclusions about the leading cause of infant death. The state Department of Health and Human Services — which administers Medicaid, the health coverage program for low-income residents, and pays for more than half of all births in South Carolina — claims accidental deaths were the No. 1 reason babies covered by Medicaid died from 2016 to 2020, according to Medicaid spokesperson Jeff Leieritz. But the state health department, where all infant death data is housed, reported birth defects as the top cause for the past several years. Accidental deaths ranked fifth among all causes in 2021, according to the 2021 health department report. All but one of those accidental infant deaths were attributed to suffocation or strangulation in bed. Meanwhile, infant mortality is a topic that continues to get little, if any, attention, especially in the South. A group called the South Carolina Birth Outcomes Initiative meets regularly to talk strategy, but this consortium of the state’s top doctors, nurses, health insurers, and hospital leaders can’t solve fundamental problems, like teaching parents safe sleep habits or connecting all pregnant women to basic prenatal care. According to the Medicaid agency, nearly half of Medicaid-enrolled babies who died before their 1st birthday in 2021 were born to mothers who received no prenatal care. “There’s good work going on. It’s just in little patches. It’s just not spread out enough to change our overall numbers,” said Rick Foster, a retired physician and former chairman of one of the Birth Outcomes Initiative’s working groups. Expanding access to maternal care South Carolina and several other states recently extended postpartum Medicaid coverage for women who give birth, which means their coverage remains in place for one year after delivery. Historically, Medicaid coverage was cut off 60 days after having a baby. Some experts believe expanding Medicaid coverage to single, working adults who aren’t pregnant and don’t have children — something most Southern states have failed to do — would also help curtail infant deaths. A woman who is healthy when heading into pregnancy is more likely to give birth to a healthy baby because the health of the mother correlates to the health of the infant. But many women don’t qualify for Medicaid coverage until they become pregnant. Even when they become pregnant and are newly eligible for Medicaid, it isn’t unusual for women in South Carolina to put off seeing a doctor until the third trimester, physicians told KFF Health News. These women can’t afford to take time off work, can’t find child care, or don’t have a car, among other reasons. Telehealth could improve access if the state’s broadband network were better, said Simmer, the state health department director. The department could also invest in a fleet of mobile vans that provide prenatal care. Each costs just under $1 million, he said. Ultimately, South Carolina needs more doctors willing to practice in rural areas. Fourteen of its 46 counties lack a single OB-GYN, Simmer said. “We don’t have providers where we need them,” he said. To that end, he added, the state might consider using student loan forgiveness programs as an incentive for new medical school graduates to practice in rural areas of the state, where obstetricians are scarce. Meanwhile, two programs aimed at improving infant mortality in South Carolina, which were backed by millions of dollars in public and private funding over the past decade, were unsuccessful in hitting the goal. The Nurse-Family Partnership, for example, which pairs expectant South Carolina mothers with nurses for at-home visits, didn’t have a statistically significant effect on birth outcomes, according to an analysis of the multiyear project, published by the Harvard T.H. Chan School of Public Health. CenteringPregnancy, a separate program that offers small-group prenatal education to pregnant women, also failed to improve birth outcomes, said Amy Crockett, a maternal-fetal specialist in Greenville and one of the lead investigators for the state initiative. Crockett said she recently returned about $300,000 in grant funding to the Duke Endowment, a nonprofit that funds health, faith, and education initiatives in the Carolinas, because the evidence to support ongoing CenteringPregnancy projects simply wasn’t there. “It’s not the silver bullet we thought it would be,” Crockett said. “It’s time to move on.” Birth outcomes experts agreed that racism and poverty lie at the heart of this difficult problem, which disproportionately threatens Black infants and mothers in the rural South. Research shows that white doctors are often prejudiced against Black patients and minimize their concerns and pain. In South Carolina, the maternal mortality rate increased by nearly 10% from 2018 to 2019, according to the latest data, which found that the risk of pregnancy-related death for Black mothers was 67% higher than for white mothers. Upon review, the state health department determined 80% of those pregnancy-related deaths were preventable. Disparities related to both infant and maternal deaths deserve urgent attention from both the federal and state governments, said Scott Sullivan, division chief of maternal-fetal medicine at Inova Health System in Northern Virginia. Hospitals also bear a huge responsibility as doctors and health care providers must learn how to fairly and adequately take care of Black women and children. “The idea that we’re going to solve 400 years of racism in an hour’s worth of bias training is a cruel joke. Systems have to remodel their approach,” Sullivan said. “It’s going to take funding, and it’s going to take a sustained effort.” Have a question about this story? Do you see something we missed? Send an email to news@carolinapublicpress.org. _____ KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF. This article first appeared on North Carolina Health News and is republished here under a Creative Commons license.

North Carolina recently expanded Medicaid to more than 600,000 people. The state-federal partnership provides health insurance to the needy. The move will bring billions in federal dollars to the state because states cover only 10 percent of the expansion costs, and the federal government covers 90 percent. North Carolina is one of the last states, 40th, to expand Medicaid. The move is too-little-too-late for East Carolina University’s rural health system, which lost $46 million last year. The system recently closed five clinics— a women’s care clinic in Williamston, an urgent care in Wilson, and family medicine clinics in Jacksonville and Aurora plus a behavioral health center. (The behavioral-health beds will go to a new facility under development in Greenville.) Eleven rural hospitals have closed in North Carolina since 2005. Rural residents are 40% more likely to be uninsured, and eligible for Medicaid. Rural health clinics serve lots of workers who fall into coverage gaps, possibly needing two or more jobs to afford health care—for instance, child care, restaurant, and nursing home workers. Republican opponents to Medicaid in Congress view it as “welfare.” The program covers one in five Americans, and funds long-term care for most Americans. House Republicans have proposed a Medicaid work requirement, part of a deal for increasing the federal debt limit, but how much could that help? Two-thirds of Medicaid spending is concentrated on the elderly and disabled; most able-bodied Medicaid recipients already work. A Kaiser Family Foundation (KFF) poll finds broad public support for Medicaid. Two-thirds of U.S. adults say they’ve had some connection to Medicaid, including health insurance (59 percent); pregnancy, home health, or nursing home care (31 percent); coverage for a child (31 percent); or to help paying Medicare premiums (23 percent.) Seventy-nine percent of Democrats and 60 percent of independents view Medicaid as a “government program helping people pay for health insurance,” while 54 percent of Republicans, see it as welfare. Republicans with a connection to Medicaid—say, an elderly loved-one in a nursing home—are more likely to see it as a program that helps people afford health insurance. Another KFF study found that Medicaid expansion improves hospital and provider balance sheets, still challenged by lingering pandemic effects, declining federal relief, and pressure on wages. Recent studies show benefits from Medicaid expansion include lower overall mortality, reduced food insecurity, poverty, and home evictions, as well as self-reported improvements in health and healthy behaviors. As the insurance covers more and more poor people, hospitals’ uncompensated care costs decline; states also save on mental and behavioral health programs, and costs of covering the incarcerated. The 90 percent of Medicaid money provided by federal dollars represents, on average, 55.1 percent of state budgets. As that money circulates, the spending generates economic benefits. Health insurance needs aren’t going away. North Carolina is coping with an opioid epidemic—overdoses rose by 22 percent in 2021, according to the N.C. Department of Health and Human Services, the latest figures available. About 40 percent of overdose patients in emergency departments are uninsured, and they require follow-up care. Medicaid may be welfare—the health, happiness, prosperity, of a person, group, or organization—it’s cost effective, improves health outcomes, and lives. We’re all better off. Betty Joyce Nash reported for the Greensboro News & Record and the Hendersonville Times-News before moving to Virginia where she worked as an economics writer for the Federal Reserve Bank of Richmond. She co-edited Lock & Load: Armed Fiction, an anthology of literary short stories that probe Americans' complicated relationship to firearms. (University of New Mexico Press, 2017.)

The current debate about the debt ceiling in Congress affects every household and business in Western North Carolina. It’s critical that our representatives in Congress understand that we want sound fiscal policy, not brinksmanship that threatens to damage our economy and undermine our financial stability. A recent survey sent to his Western North Carolina constituents by 11th District U.S. Rep. Chuck Edwards can be deceptive without careful reading. Before you respond, read the survey carefully. The survey itself requires a “No” answer to support raising the debt ceiling, even though the subject line of the email would require a “Yes” response if you are in favor of taking this critical step to prevent fiscal calamity. Our nation's debts come from past spending and tax bills. Responsibility for the current debt lies equally (50 percent each) with Democrat and Republican spending and tax policies. Both are equally responsible. Blaming each other is a distraction from responsible fiscal policy. Fiscal policy requires both responsible spending and responsible taxation. Continually cutting taxes on corporations and the wealthy is as irresponsible as pork barrel spending. The blame game and playing chicken with our nation's debt doesn’t solve this. Our current debt is not a threat to our economic viability. Stalling the debt ceiling approval is a threat. The important number to follow is our debt to GDP ratio. That tells us if we can service our debt. Banks use this for households when granting a loan. We need to use the same number. Most households, corporations, and businesses have debt greater than their revenues. Our nation's debt to GDP is currently falling and was 123.4% last quarter. It was 123.6% the previous quarter and was 132.4% in March 2021. The US is considered a responsible fiscal manager, so we can borrow at low interest rates. The Treasury interest rate is the risk-free rate because we are trusted to pay our bills. Threatening that trust in the United States will have big economic consequences nationally and globally. If you don’t pay your bills, it costs you more to borrow and you may not be able to borrow. The same can happen to a nation that fails to pay its bills. Not only will economic chaos result if Congress fails to raise the debt ceiling, the action will also undermine our security, as Defense Secretary Lloyd Austin has warned. "If the United States defaults, it would undermine the economic strength on which our national security rests," Austin said in a statement. "It would also seriously harm our service members and their families because, as secretary, I would have no authority or ability to ensure that our service members, civilians, or contractors would be paid in full or on time." Congress needs to raise the debt ceiling. Then it can negotiate responsible tax and spending policies. Susan Kask is a business and economic consultant and is retired from a 30-plus year career doing research and teaching economics.

The current debate over the national debt and the potential for it to crash the economy right before summer starts is, frankly, funny. Not “tee-hee ha ha’’ funny but funny in that anyone believes the base arguments being put forth by some newly converted debt zealots in the U.S. House. Now, the debt is a serious issue. We’re spending around 8 percent of the budget just to service it every year. We’ve had the luxury of interest rates hovering around the non-existent mark for quite a while that kept debt service from rising higher. But those days are gone, maybe for good. So, yes, we need to pay down the debt. But the solutions being offered definitely leave defense spending off the table and likely leave Social Security and a lot of health care spending off as well (and no, those aren’t entitlements, we pay taxes for them). What’s left of the budget elephant is a couple of toenails and there isn’t any way trimming them is going to bring the debt down in any serious fashion. There’s another factor about the lack of seriousness among the latest round of budget hawks, and we’ll get to that in a bit. First, let’s look at how we got here, and how we’ve solved this problem in the past. The U.S. was in a little thing called World War II back in the 1940s, and winning that war meant building things like planes and tanks and aircraft carriers, and that cost money. And that meant debt. A booming post-war economy helped bring down the WWII debt without much effort. The sources of federal revenues were different back in those days. According to the Tax Foundation in FY 1954 the pie was 42.4 percent individual income taxes, 30.3 percent corporate taxes, 10.3 percent social insurance and retirement receipts, 14.3 percent excise taxes and 2.7 percent “other.’’ Fast-forward to 2019 and the numbers were 50 percent individual taxes, 7 percent corporate taxes, 36 percent payroll taxes and 8 percent excise, estate and other taxes. Now, the big picture is more complicated, as what is a defined as a corporation has changed a lot over the years. But what is an individual hasn’t, aside from Mitt Romney’s “corporations are people too.’’ And the top rate for individuals after WWII was more than 90 percent. LBJ knocked that down to around 70 percent and Ronald Reagan dropped it to 50 percent and then 28 percent by the time he left office. And in his time in office the debt ballooned, so maybe there’s a connection there. And as for the late '40s and '50s, despite the high top tax rate, there were still plenty of incredibly wealthy people, although we’ll concede they weren’t wealthy enough to be shooting themselves into space left and right. (Also, U.S. rockets had a tendency to blow up in that era, so there’s that). So now let’s get to the point of this article by jumping forward to the year 2000. Efforts to tighten the budget had paid off, and the country had a realistic chance of erasing the debt in a decade. So, what happened? The PEEPhole happened, that’s what. Deficit hawks, suddenly and probably unexpectedly confronted with a pile of surplus money, went the popular route: “That money belongs to THE PEEPhole! The PEEPhole know what’s best to do with their own money and we should give it back to the PEEPhole!” Politically popular? You betcha. The PEEPhole loved it. Remember those checks coming in the mailbox for $600 and $300? Those were swell. They were part of George Bush’s $1.35 trillion tax cut, a lot which of went to folks who would have been just fine without it. Those were swell. They were part of George Bush’s $1.35 trillion tax cut, a lot of went to folks who would have been just fine without it. The U.S. Treasury wound up having to borrow money to cover the tax rebate checks. And so, we come at last to today in the Year of Our Lord 2023. Deficit hawks are at it again, threatening default as they did in 2011 and 2013. Now, a lot of those hawks were just fine with President Donald Trump grabbing the debt tree and giving it a good hard shake for his round of tax cuts, so the new obsession with debt is … curious. But let’s say they get a deal that ends with a surplus – and that’s a big if – does anyone really think we won’t see these carnival barkers rear up on their hind legs and start braying about “the PEEPhole’’ and how they deserve their money back? And how that argument will logically turn to how the “PEEPhole’’ at the top, when they’re not in low-earth orbit, are paying the most and need to be refunded the most? It’s an old argument that sounds logical and is very appealing to the rest of us who are having trouble paying for a car or a dozen eggs and will get a little relief. In practice, well… let’s play around with the clock one last time, turning it back to 1932: “The money was all appropriated for the top in the hopes that it would trickle down to the needy. Mr. Hoover was an engineer. He knew that water trickles down. Put it uphill and let it go and it will reach the driest little spot. But he didn’t know that money trickled up. Give it to the people at the bottom and the people at the top will have it before night, anyhow. But it will at least have passed through the poor fellow’s hands.” Will Rogers was right 91 years ago about the yet-to-be-coined “trickle-down theory.” He was right about a lot of things when it comes to human nature. He’d get a hoot out of the current debt showdown and the players involved. And he’d wonder why the “PEEPhole’’ elected so many of those loons. Jim Buchanan is a longtime mountain journalist and author.

In the United States, and in North Carolina, we learn at an early age the concept and practice of fairness, which is the quality or state of being fair. In our legal system, we allow adversaries to hear evidence, to question witnesses and encourage jurors to take the facts and render a fair and just verdict. The point is we consider our society to be a nation of justice and fairness. Yet the North Carolina House members have changed rules of fairness that have been in place for more than a decade. If you have not been keeping track, the N.C. House Republicans voted to remove the rule on veto-override votes. Previously, the House rules passed and approved stated that House members could not vote to override a gubernatorial veto “until the second legislative day following notice of its placement on the calendar. The new rule flies in the face of fairness, which is a dying concept in these days of political partisanship. The notion is fading that elected officials represent the people. Many representatives focus on supporting a political cultural and power agenda, fairness be damned. An example of one-sided government is the change of Feb. 15, when the NC House of Representatives passed a rule that allows votes to override Governor Cooper’s, and future governors’ vetoes, without notifying House legislators before a vote is taken. This is a significant change and one that lacks transparency and fairness for the people of North Carolina. The prior rule did not permit a vote to override a gubernatorial veto until the second legislative day, following notice of its placement on the calendar. This rule has been in place for many years and has worked for the legislators, the governor and, most importantly, the residents of North Carolina. With a Republican majority, the rule changes make it imperative that Democratic legislators be present if they hope to support a veto by the governor. Why is this? It’s because the Speaker has the power to change the order of business. Legislators now rely on the fairness and transparency of the Speaker’s actions. Is this possible, given the partisanship we have witnessed over the 12 years of Republican control of the Legislature and the Speakership? Who wins in this situation? You would think voters rely on legislators and the governor to work together for the betterment of the people, not their political agenda for gaining more and more power over government and the people who elected them to govern for the good of the people and the State. What can be done to address this inequity? Nothing at this time. The voters of the State ultimately are the decision-makers if they support this form of power-grab government. It is not enough for Republicans to suppress the vote across the country, including North Carolina, it is clear the Republicans are laser-focused on changing the outcomes of all elections in their favor. Their reward? To appoint officials who will claim ‘voter fraud’ in elections if their party’s candidates lose? Our nation is in peril as democracy continues to be attacked. Our enemies are watching for the chance to take advantage of our divisive political and social culture to use cyber and possibly military force to attack. Don’t take these power grabs as singular events. Ask yourself: Who can protect our democracy? It is not the politicians. It is the people and voters of North Carolina and the nation. Virgil L. Smith formerly served as president and publisher of the Asheville Citizen-Times and Vice President for Human Resources for the Gannett Company. He is the principal for the Smith Edwards Group and the author of "The Keys to Effective Leadership - Understanding Who You Are and Tips on Being a Successful Leader." He is the founder and writes for Carolina Commentary.

North Carolina may finally be on the verge of finding its “compassion and common sense” in the words of Mary Scott Winstead, spokeswoman for Gov. Roy Cooper. Winstead’s remark, made in an email to the Associated Press, disparaged the fact that North Carolina is one of the last states that haven’t extended Medicaid coverage to hundreds of thousands of people eligible under a federal program that would pay 90 percent of the cost. That may be about to change. A bill to expand Medicaid coverage easily gained approval in the state House earlier this week. But the bill could still falter in the Senate over a disagreement among Republican lawmakers about whether to saddle it with other changes to the health care system that are opposed by hospitals and doctors. Rep. Donny Lambeth, R-Forsyth, a retired Health care executive, filed House Bill 76, Access to Health Care Options Feb. 9. The Department of Health and Human Services estimates it would extend health care coverage to as many as 600,000 low-income uninsured North Carolinians. A similar bill, passed in the Senate last year, failed in the House because it contained provisions that would repeal North Carolina’s certificate-of-need rules and would allow nurses with advanced training to perform more medical procedures without a doctor’s supervision. Opposition from lobbies for doctors and hospitals killed that bill. Lambeth’s bill doesn’t contain those provisions but they could be added in the Senate, where Senate leader Phil Berger has made his support for Medicaid expansion contingent on them in the past. Those changes to the health care system are separate issues that should be decided on their merits, just as Medicaid expansion should be decided on its merit. And if lawmakers ever encountered an incontrovertible choice, expanding Medicaid is it. The federal government will pay 90 percent of the cost. A section of Lambeth’s bill would implement the Healthcare Access and Stabilization Program, which would increase the amount hospitals ar e paid to care for Medicaid patients to an amount closer to the actual cost. In return, hospitals and health care plans would cover the remaining 10 percent. According to Lambeth, about 70 percent of those who would qualify for coverage if Medicaid is expanded already work, including many nursing home, home health, childcare, restaurant, hotel and grocery employees. Instead of establishing a work requirement, something the courts have struck down in other states, Lambeth’s bill creates a comprehensive workforce development program called NC Health Works that would match recipients with training and job opportunities. This section is modeled on a similar program in Montana where 78 percent of unemployed participants found employment after completing the program, according to a report prepared for the Montana Healthcare Foundation. The economic benefit of reduced sick time and increased productivity resulting from a healthier workforce can’t be easily measured, but job growth can be. A report in Michigan found that new economic activity associated with expanded Medicaid spending resulted in the creation of 30,000 new jobs. “Our analysis suggests that for individual states … there are economic benefits to the state and state government that far outweigh the cost of … Medicaid expansion,” Dr. John Ayanian, said in a 2017 interview with New England Journal of Medicine Managing Editor Stephen Morrissey. Ayanian, director of the University of Michigan Institute for Health Care Policy and Innovation, said about one-third of the new jobs were in the health care industry. The remainder were created in other sectors as health care spending flowed through the economy and caused a multiplier effect. The additional spending netted the Michigan government an additional $150 million in sales tax and income revenue. Medicaid was signed into law in 1965 along with the law that created Medicare. All states have Medicaid health coverage for some low-income people. The federal government pays about 70 percent and requires states to make it available to certain groups. States have considerable discretion at setting income eligibility levels. To qualify in North Carolina you must be a caregiver for a child 18 years of age or younger or a disabled family member and make less than 40 percent of the federal poverty level. Or you must be blind, have a disability, or be older than age 65 and have an income of less than 100 percent of the federal poverty level. Non-disabled, childless adults ages 19-64 are not eligible for Medicaid coverage. Beginning in 2014, the Affordable Care Act offered states the option to expand eligibility for Medicaid to all persons with an annual income of less than 138 percent of the federal poverty level. For 2023, the income threshold to qualify for a single person would be $20,120. The COVID-19 relief bill passed in March 2021 included financial enticements for North Carolina and the other holdout states to expand Medicaid. If it does so, North Carolina could get $1.5 billion or more as a signing bonus. Some lawmakers are talking about using $1 billion of that to shore up the state’s pitifully inadequate mental health system. But the bonus comes with the condition that states agree not to put stipulations on enrollees. A workforce amendment added to the bill creates a contingency that requires the state to develop a work requirement plan if the federal government should authorize it. That may disqualify North Carolina from getting the bonus. That would be an outrageous case of politics trumping good judgment. North Carolina taxpayers paid their share of the federal money being used to fund Medicaid expansion and they deserve to have their share of those tax dollars returned to benefit our state. North Carolina can increase federal funding for health care by $8 billion annually and potentially an additional $1.5 billion one-time signing bonus by expanding Medicaid and implementing the Hospital Access and Stabilization Program. There can be no justification for burdening a bill that so obviously benefits so many people in North Carolina, at virtually no cost to the general fund, with controversial amendments that have already scuttled it once. North Carolina is one of 11 states that have not adopted Medicaid expansion. It’s long past time for North Carolina lawmakers to choose “compassion and common sense.” Joy Franklin is a journalist and writer who served as editorial page editor of the Asheville Citizen-Times for 10 years. Prior to that she served as executive editor of the Times-News in Hendersonville, N.C. Franklin writes for Carolina Commentary.