Duke University Health Policy Expert: The Case Against Medicaid Expansion in North Carolina
Article knocks down arguments about Medicaid expansion that Democrats continue to use today
Raleigh, N.C. – Earlier this week, Democrats continued their efforts to expand Medicaid in North Carolina, holding a hearing on the topic at the legislature. In light of that renewed push, it’s worth revisiting an article published in the North Carolina Medical Journal in 2017. Christopher Conover, a Research Scholar in the Center for Health Policy & Inequalities Research at Duke University, outlined a number of reasons why Medicaid Expansion is not a good idea for North Carolina that directly rebut some of the benefits being touted by Democrats. .
1) Medicaid Expansion Will Reduce Access for Existing Medicaid RecipientsConover explains that due to Medicaid’s low reimbursement rates, many Medicaid enrollees already have difficulty locating a provider, an issue that expanding Medicaid would only exacerbate:
” A model developed by the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill showed that, in the year 2020 alone, Medicaid expansion would increase the unmet demand for physician services by over 25%. In the context of this physician shortage, it makes little sense on ethical or clinical grounds to divert care away from existing Medicaid beneficiaries, who are among our most vulnerable populations—elderly individuals, persons with disabilities, pregnant women, infants, and children. “
2) Medicaid Expansion is Unlikely to Save LivesConover points out that there is no concrete evidence to back up the argument that expanding Medicaid will save lives:
“The best available evidence regarding Medicaid’s actual impact on health and mortality risk comes from the Oregon Health Study, which is as close to a randomized controlled trial as we might ever get on this question. In that study, Medicaid ‘generated no significant improvement in measured physical health outcomes,’ nor did it result in a statistically significant reduction in mortality risk.”
3) Medicaid Expansion is Unaffordable in the Long RunConover makes the point that it is extremely unlikely the federal government will continue to fund Medicaid expansion at the current levels, especially considering the fact that enrollment levels and the cost of expansion have been much higher than predicted:
The most recent annual report on Medicaid’s finances issued by the US Department of Health and Human Services (HHS) showed that the average cost of the ACA’s Medicaid expansion enrollees was nearly 50% higher in FY 2015 than HHS had projected just 1 year previously. Additionally, enrollment exceeded projections in states that elected to expand Medicaid by 110% nationally, and this problem has been much more severe in some states. Expansion enrollment exceeded projections by 322% in California, by 276% in New York, and by 134% in Kentucky. “
4) Medicaid Expansion will Eliminate More Jobs than it CreatesClaims that expanding Medicaid will bring thousands of new health care jobs to North Carolina is one of the benefits of expansion that supporters continue to mention, but Conover points out that these jobs come at a cost:
“The RAND Corporation has shown that every new job added to the health care sector results in 0.85 fewer jobs in the rest of the economy. Even worse is that every $1 raised in taxes shrinks the economy by 44 cents. This implies we would lose 144 jobs for every 100 health sector–related jobs that might be induced by expansion. In the end, then, Medicaid expansion is not merely a break-even proposition that shifts jobs from the general economy into the health sector: it actually reduces total employment in the economy overall.”

Meet your new (2019-21) GOP Board:

Chairman: Jeff Hullender

Vice Chair: Jane Briggs

Treasurer: Roberta Lewis

Secretary: Currently open

Senator Ralph Hise

Legislative Update
47th District, North Carolina Senate

312 Legislative Office Building, Raleigh, NC 27603-5925
Phone: 919.733.3460 E-Mail: Ralph.Hise@ncleg.net

Volume 8, Issue 7                                             July 2, 2018


The General Assembly adjourned Friday after a legislative short session that saw many accomplishments. We passed a budget that, among other things, delivered a fifth consecutive teacher pay raise, major tax relief to families and businesses, and significant pay raises to state employees, corrections officers and state troopers. We passed bills that protect North Carolina farmers, significantly expand early voting, improve election security and provide additional learning opportunities to thousands of children from low-income families across the state. Finally, we proposed six constitutional amendments, described below, that will go before the voters in November to decide whether they are permanently enshrined in the North Carolina Constitution. I am proud of all the Senate was able to accomplish over the past two months.


Photo ID Constitutional Amendment

Voters will choose whether to make North Carolina the 34th state to require ID at the polls, after the General Assembly approved a proposed constitutional amendment that will appear on the November 2018 ballot.

If a majority of voters agree, the proposal will amend the state constitution to require that North Carolina citizens show photo identification in order to cast their votes in person.

Currently, North Carolina is the last state in the Southeast not to have some form of voter ID at the polls. Voter ID was upheld by the United States Supreme Court in 2008.

Polls have shown voter ID is hugely popular in North Carolina and across the country.

 Constitutional Amendment Cutting the Cap on N.C. Income Taxes

The General Assembly also approved a proposed constitutional amendment that will empower voters to decide whether to lower the state’s maximum possible income tax rate from 10 percent to seven percent. Senate Bill 75 will appear on the November 2018 ballot.

Since assuming leadership of the General Assembly in 2011, legislative Republicans have overhauled the state’s tax code, lowering rates and eliminating dozens of loopholes – resulting in the vast majority of North Carolinians keeping more of their own tax dollars. The changes have also helped create hundreds of thousands of new jobs and consecutive budget surpluses. If voters approve, the amendment will help ensure the state does not reverse course on those reforms and return to burdening North Carolinians with some of the highest taxes in the Southeast, as it did when Democrats last controlled state government in 2010.

Constitutional Amendment Establishing a Bipartisan State Board of Ethics and Elections

Voters will choose whether to permanently establish a Bipartisan State Board of Ethics and Elections Enforcement in our state’s constitution this fall.

House Bill 913 would establish an eight-member, bipartisan board to administer North Carolina’s ethics and elections laws, free from the influence from the legislative, executive, or judicial branches of state government. Polling showsnearly 80 percent of North Carolinians support a bipartisan approach.

Members of the bipartisan board would serve four-year terms and would be appointed by House and Senate leaders based on recommendations from leaders of both the majority and minority parties. The proposal makes clear that no more than four members of the board could be registered with the same political party, and that the balance of the board’s membership would not be directly impacted if control of the legislature switched from one party to another – ensuring that ethics and elections enforcement is not encumbered by partisan politics. Unaffiliated citizens would also be eligible for any position on the board.

Constitutional Amendment Establishing a Merit System to Fill Judicial Vacancies Between Elections

Voters will have an opportunity to amend North Carolina’s Constitution this fall to implement a non-partisan, merit-based system to fill judicial vacancies between elections.

Senate Bill 814, the Judicial Vacancy Sunshine Amendment,, will allow voters to consider a constitutional amendment on the November 2018 ballot that would:

·        Empower the people of the state to nominate candidates to fill judicial vacancies.

·        Authorize a non-partisan merit commission, appointed by the Chief Justice, the governor and the General Assembly, to evaluate those nominees and rate them based on their professional qualifications and merit.

·        Direct the General Assembly to review the qualified nominees submitted by the nonpartisan commission and forward at least two nominees to the governor for consideration.

·        Provide that the governor will appoint the nominee he or she considers most qualified to serve a provisional judicial term.

·        Require the appointed judge to stand for election following the governor’s appointment in order to continue holding the judicial office.

The Judicial Vacancy Sunshine Amendment would not change the process for regular judicial elections. But it would end the practice of patronage judicial appointments like WRAL’s report of former Gov. Bev Perdue’s appointment of three of her employees to judgeships on her last day in office.

Constitutional Amendment to Expand Victims’ Rights

In bipartisan votes, the North Carolina Senate and House both passed legislation that will let voters consider a constitutional amendment on the November 2018 ballot to expand the rights of victims of crime and their families.

A victims’ rights amendment was added to North Carolina’s Constitution in 1996, which gave some crime victims basic rights to participate in the justice system, butHouse Bill 551 further advances those rights by doing the following:

·        Expands the scope of crimes under which protections to victims are extended.

·        Requires that victims receive effective and timely notice of all court proceedings.

·        Expands victims’ rights to those victimized by juveniles.

·        Gives victims a greater voice in the process by allowing them to be heard at plea, conviction, sentencing, or adjudication hearings.

·        Creates an enforcement mechanism which allows a victim to file a motion with the court if they are being deprived of their rights.

While protecting the rights of victims, the bill makes sure that those rights do not infringe upon the rights of the accused.

Constitutional Amendment Protecting Right to Hunt and Fish

In bipartisan votes, both the North Carolina Senate and House of Representatives passed legislation that will let voters choose whether to amend the North Carolina Constitution to safeguard citizens’ right to hunt, fish, and harvest wildlife.

 Senate Bill 677 had bipartisan support in both bodies, and voters will now consider the constitutional amendment on the November 2018 ballot. Twenty-one other states already guarantee this right in their constitutions.

General Assembly Overrides Governor’s Veto of Early Voting Expansion

The General Assembly recently voted to override Gov. Roy Cooper’s veto of Senate Bill 325, which would expand opportunities for voters to cast ballots during the earlyvoting period and direct counties to adopt a uniform schedule for early voting sites.

The bill would place early voting on a uniform schedule statewide of 7 a.m. to 7 p.m. on weekdays, offering increased early voting hours during the week so North Carolinians have more opportunities to cast a ballot. It would require all voting sites in a county to be open during that county’s early voting hours, reducing confusion for voters as to where they can vote.  Finally, it would add an additional full day of early voting, moving North Carolina from 16.5 to 17 days of early voting.

Additionally, on Thursday, both the Senate and House passed House Bill 335 which restores the final Saturday of early voting.


Thank you for the opportunity to continue representing you in the North Carolina Senate. As always, please feel free to contact my office at any time with your concerns or questions.

Best regards,

Senator Ralph Hise

47th District


Monday, August 21, 2017






Former Durham County Elections Worker Indicted


RALEIGH, N.C. – A Durham County grand jury on Monday indicted a former Durham County elections worker on charges related to the mishandling of provisional ballot results during the March 2016 primary election.


The grand jury returned indictments against Richard Robert Rawling, 59, of Cary, on counts of obstruction of justice, a felony, and failure to discharge a duty of his office, a misdemeanor.


Investigators from the then-N.C. State Board of Elections (now called the Bipartisan State Board of Elections & Ethics Enforcement) found that irregularities resulting from Rawling’s actions were not sufficient in number to affect any contest outcomes. It also found no evidence that Rawling altered ballot counts to support a particular political party or candidate.


Rather, the investigation determined that Rawling ran or ordered subordinates to run provisional ballots through tabulators more than once and made manual changes to the ballot count so the results of the provisional canvass would match the number of approved provisional ballots. That was done, the investigation found, to avoid having to report to the Durham County Board of Elections a discrepancy in the number of provisional ballots in possession of the Board of Elections and the number counted on canvass day.


“The State Board’s top priority is ensuring the integrity of elections so voters have confidence in the process,” said Kim Westbrook Strach, executive director of the State Board of Elections & Ethics Enforcement. “We will continue to hold accountable elections workers and voters who violate election laws.”


Voters cast provisional ballots when there is a question about whether they are eligible to vote in a particular election or contest.


Unlike regular ballots, provisional ballots are not run through tabulators at the polling place, but are collected and delivered to the county board of elections to determine whether they should be counted. Provisional ballots deemed acceptable are then run through tabulators on county canvass day.


Rawling worked for the Durham County Board of Elections during the March 15 primary, but resigned later that month. When Durham County elections officials notified State Board investigators about the issue in early April 2016, the State Board office opened an investigation. In October 2016, investigators provided a full report to the Durham County district attorney for possible prosecution.


Derek Bowens, the former elections director in New Hanover County, took over as Durham County’s elections director in June 2017. This incident occurred under a former director.


The destruction of monuments and other objects of remembrance throughout history did not erase the history they represented.

  • In 1944, Nazi Germany destroyed numerous buildings, castles and parks in Poland.
  • From 1959 to 1964, Nikita Khrushchev closed and/or destroyed more than 10,000 mostly-rural churches as part of his anti-religious campaign in the Soviet Union.
  • In 2001, the Taliban destroyed 6th century Buddha statues they declared to be “heretical idols.”
  • ISIS has destroyed countless historical monuments and artifacts. Their acts have been referred to as a “cultural cleansing.”

We are Americans. We preserve our past and our heritage so we may learn from our successes and our failures.

Destruction of monuments dedicated to historical figures and heroes of our past will not delete the history they represent. In fact, their destruction will only divide us further.

Today, the target of cultural cleansing is Civil War and Confederate monuments. If you support destruction of monuments to that part of our shared history, who is to say monuments to a part of history you want to protect won’t be a target tomorrow?

Destruction of monuments is a slippery slope, indeed.

Hundreds of thousands of Americans died during the U.S. Civil War. Monuments and statues across our state commemorate the sacrifices of some 40,000 North Carolinians who died during the war – and the families who sacrificed with them.

In 2015, I voted in favor of a bill that protects all monuments across our state equally from destruction and removal. I stand by that vote, and I will not vote to lessen the protection of monuments should the occasion arise.

If you were to dedicate your time and energy to erecting a monument today, would you want future generations to tear it down in a fit of short-sighted rage? No, you dedicated your time and energy to that purpose because you wanted future generations to remember something significant.

Monuments that our forbearers built should remain so we and future generations may learn from our past.

Willful destruction of property against monuments dedicated to our past and the general lawlessness and violence that surrounded acts of the past week cannot be tolerated. I support the Durham County sheriff’s decision to charge those involved in the destruction of a monument in Durham on Monday.

Gov. Roy Cooper said this week that monuments should come down, and the history they represent belongs in museums and textbooks. If he got his way, removal of that history from textbooks and museums would be next.

You cannot rewrite our history, Gov. Cooper. I will not be party to any attempt to do so.

Michele Presnell


President Pro Tempore

Senator Phil Berger


2007 Legislative Building

Raleigh, N.C. 27601


Contact: Amy Auth, 919-301-1737

Shelly Carver, 919-301-1744

April 21, 2017

Berger Responds to State Board of Elections Audit Findings


Raleigh, N.C. – Senate Leader Phil Berger (R-Rockingham) responded Friday to a State Board of Elections audit that found more than 500 ineligible votes were cast in North Carolina during the 2016 general election:


“We appreciate the State Board of Elections’ efforts to investigate these types of irregularities, which undermine confidence in the integrity of our elections, and to share their findings with the public,” said Berger. “If even one fraudulently cast ballot effectively disenfranchises a legitimate voter, then that is one too many, and that’s why we continue to support commonsense policies like voter ID that improve voter confidence.”


In addition to the audit’s findings, a federal investigation into coordinated voter fraud in Bladen County is currently ongoing.