House District 75 candidates at odds over Medicaid expansion

Healthcare is front and center in the state House District 75 race, which pits Republican incumbent Donny Lambeth against Democratic Dan Besse, in suburban Forsyth County.

Few would have predicted two years ago that Republican Donny Lambeth would be fighting to hold on to his seat in the state House in this election. Lambeth ran unopposed for District 75, which stretches across the southern portion of Forsyth County from Kernersville to Clemmons, in his first election in 2012 and has faced only nominal opposition since then.

Lambeth’s Democratic opponent, Dan Besse, is a longtime Winston-Salem City Council member with a long track record of activism in the Democratic Party. The two candidates share a thoughtful approach to policymaking and long records of public service, although Besse is a bit more pugnacious than Lambeth, who dislikes political combat.

Besse said he had been fielding requests from Democratic lawmakers to run for the District 75 seat since the beginning of the year, but what ultimately persuaded him was a call from Democratic Gov. Roy Cooper.

“The governor finally called me and said, ‘We want you to run, and you can help with healthcare,’” Besse recounted. “The reason they persuaded me was healthcare, education, and clean water and air.”

Lambeth received a similar summons from his party leadership when he took office in 2013, albeit from then House Speaker Thom Tillis, who is now the junior senator from North Carolina in the US Senate. Lambeth had recently retired as president of Lexington Medical Center and Davie Hospital, part of the Wake Forest Baptist Health system, and also chaired the Winston-Salem/Forsyth County School Board at the time.

“I talked to Speaker Tillis about spending time on education,” Lambeth recalled. “That’s my passion. He said, ‘No, you’re going to focus on healthcare. That’s where I need you.’”

Lambeth has leveraged his background as a hospital administrator into forecasting the state’s future needs. Among the issues he says the state needs to manage is the difficulty recruiting doctors in rural areas, increasing costs as the population ages and technological advances that allow urban hospitals to collaborate with their rural counterparts to expand access to services like stroke and chest-pain programs through telemedicine.

Besse is making a frontal attack on Lambeth’s record on healthcare, particularly on the issue of Medicaid expansion.

“As uncomfortable as the fact may make him, Donny Lambeth voted on party lines to prohibit North Carolina from expanding Medicaid within two months of taking office in 2013,” Besse said. “That disappointed many of us.”

Besse cites research that indicates expanding Medicaid coverage in North Carolina would recoup $2 billion in taxes that residents have already paid the federal government, provide healthcare to 600,000 people and create 40,000 jobs.

“Continuing to refuse to expand Medicaid is immoral and fundamentally economically stupid,” Besse said.

Lambeth said that while he doesn’t support Medicaid expansion, he’s tried to achieve the same goal through other means.

“My party has not been favorable towards Medicaid expansion,” Lambeth acknowledged. “When I was told that wasn’t going to happen, I worked on an alternative called Carolina Cares.”

Lambeth’s bill, which was filed in 2017, attempts to expand coverage through the private insurance market instead of Medicaid. It includes a work requirement, with exceptions for certain groups like veterans and farmers. The bill relies on funding from the federal government and providers, with no funding from the state. The plan requires subscribers to pay for coverage, but Lambeth said people who can’t afford employer plans might qualify for coverage by paying as little as 5 percent. And he said the plan would cover about 85 percent of those who are currently caught in the Medicaid gap. Lambeth acknowledged the legislation hasn’t gotten much traction.

“Things in Raleigh don’t move very fast,” he said. “You have to work with a lot of people to get anything done. We’ll file that bill next year if I’m elected again.”

Americans For Prosperity-North Carolina — a 501(c)4, or “social welfare organization” financed in part by the billionaire Koch brothers — plans to spend six figures on advertising and grassroots get-out-the-vote efforts to support Lambeth, along with six other Republican incumbents, according to a press release. The conservative group lauded Lambeth as “an advocate for tax reform, common-sense spending reforms, and regulatory reform. In addition to this, Representative Lambeth is a champion on reforming the healthcare regulatory environment.”

The group is also supporting Trudy Wade, a Republican incumbent defending her Senate seat in Guilford County against Democrat Michael Garrett.

Chris McCoy, the state director of Americans For Prosperity-North Carolina, did not respond to a Facebook message requesting comment for this story.

The Besse campaign quickly publicized Americans For Prosperity’s intervention in the race, trumpeting it as proof that “the Republican right wing is now so panicked about us that it’s called in their big-money shock troops to attack,” and then quickly pivoting to a fundraising request to supporters. The Oct. 10 Facebook post by the Besse campaign also took a shot at their opponent, referencing “Donny Lambeth and his buddies in the Koch Brothers network.”

After one of Lambeth’s supporters complained that the Besse campaign was misrepresenting Lambeth’s track record as a healthcare advocate, the incumbent himself chimed in on the thread. “They are desperate and not telling the truth,” Lambeth said. “Sad. But I will prevail.”

He added, “They have paid me nothing and I have never accepted an endorsement from this group.”

Campaign finance law prohibits candidates from independent election groups that don’t disclose their donors from coordinating with candidates. Lambeth said no one from Americans For Prosperity has reached out to him, and that he hasn’t seen any of their electioneering materials.

“I have not taken a dime from them or any extremist group,” he said.

Lambeth added that Americans For Prosperity’s assist is no different than what an education advocacy group running television ads attacking him for his support of constitutional amendments that the Republican majority placed on the ballot is doing for Besse.

Besse said his larger point is that Lambeth’s policies are aligned with the Koch brothers’ interests.

“His continued interest in privatization of healthcare provision [Medicaid] that had been managed well by a public entity is also completely in line with the Koch brothers’ anti-public services agenda,” Besse said. “From their standpoint, the key is all about who controls the strings of legislative power. Donny’s willingness to keep voting for the current leadership is what they want to see continue. They could care less about what an individual may do so long as they vote the way they want them to.”

While opposing the expansion of Medicaid, Lambeth has led efforts to reform the current system.

“The reason I did not vote for expansion is we had a Medicaid program in North Carolina that was broken,” Lambeth said. “We had to reform it. What I’ve done is reform it.”

He added, “We’re the largest state that has not moved to a managed-care system. He [Besse] doesn’t know healthcare. North Carolina is the last state and largest state that has not moved to managed care. Managed care monitors quality outcomes. The current Medicaid system doesn’t monitor quality outcomes.”

The Medicaid reform effort led by Lambeth was signed into law by then-Gov. Pat McCrory in 2015, but it requires federal approval for implementation. Lambeth said that hasn’t happened under either the Obama or Trump administrations.

Besse said he’s raised and spent more than $100,000, and will keep fundraising so he can hammer away at his message that his opponent’s opposition to expanding Medicaid has hurt the state.

“It’s a process where you have to work hard through the end,” Besse said. “You have to stay on your message, and you have to outwork and outsmart the other candidate.”

Lambeth argues that, considering healthcare is the second-largest item in the state budget after education, the legislature needs someone with his expertise to continue representing District 75.

“If you look at today and in the next 20 years, our population will grow from a third of people being over 60 to half being over 60,” Lambeth said. “We’re living longer, and it’s proven that healthcare costs more as you age. We’re not well positioned in North Carolina to meet the demands for healthcare. We don’t have enough primary-care physicians. We don’t have enough specialists. We need some loan forgiveness programs so people will stay and work here. We need to expand telehealth. You can’t overestimate how important it is that we meet the need to restructure our healthcare system to meet the needs of our aging populations — and I’m one of them.”