“People’s Eyes Are Starting To Open”: How Covid-19 Is Driving Support for Medicaid Expansion

GREENSBORO, N.C. — Dan Bayer sits at a laminate table in his partner’s rental duplex about dinnertime May 7, making cold calls to residents of Cabarrus County, a mostly white, rural county in the middle of North Carolina. After 50 minutes of hangups and disconnected numbers (and two people who signed the petition he’s circulating), Bayer is talking with a 59-year-old African American man. Bayer asks how he’s coping during the pandemic.

“We’re doing fine out here,” the man says. With a drawl from a childhood spent on North Carolina’s coastal plain, Bayer, a white man with long gray hair, eases the conversation toward healthcare. The man tells him, ​“Medicaid is something a lot of people need.” Bayer agrees and tells the story of a former housemate, an uninsured restaurant worker with diabetes. ​“He was always having attacks,” Bayer says. ​“There’s a lot of people who were suffering even before this present circumstance.”

Bayer, 51, is a canvasser for Down Home North Carolina, a progressive nonprofit founded in 2017 to ​“build the power of the state’s multiracial working class in small towns and rural areas.” For the past three weeks, in a state with one of the highest levels of uninsured citizens, Bayer and other volunteers have been trying to convince Cabarrus County residents to sign a petition asking the North Carolina General Assembly and Gov. Roy Cooper to expand Medicaid coverage to half a million more North Carolinians. On July 2, Gov. Cooper signed a Medicaid transformation bill that included Covid-19 relief but did not fully expand Medicaid. North Carolina is one of 13 red states, mostly in the South, where Republicans refused Affordable Care Act money to expand Medicaid eligibility.

The state has voted almost exclusively for Republican presidential candidates since 1968, as the national party exploited white conservatives’ backlash against civil rights gains. But the tides might be changing. In 2016, a slim majority of North Carolinians voted for Donald Trump — but also elected Cooper, a Democrat and Medicaid expansion advocate.

Down Home now has chapters in five mostly white, rural counties in central and western North Carolina that have experienced severe job losses — an estimated 350,000 manufacturing jobs statewide since NAFTA in the early 1990s. Through deep canvassing, Down Home identified the lack of affordable healthcare as a top concern for its counties, also hit hard by farm consolidation.

Cabarrus County chapter organizer Jasmine Wright, 28, who is African American, says in the wake of the job losses brought on by Covid-19, ​“People’s eyes are starting to open.” The Medicaid expansion would provide healthcare to hundreds of thousands of workers laid off from low-income jobs. Only Colorado and Louisiana have suffered more job losses than North Carolina during the pandemic. In one call, an 81-year-old white woman told Wright the best thing to do is to pray for the president and acknowledge his authority. Wright’s response was to bring the issue home. ​“You ask them to get a little personal, and I get personal,” she says. It turned out the woman’s son-in-law lost his job and his health coverage as a result of the pandemic. The woman ended up signing the petition.

Before Covid-19, Down Home’s organizing strategy focused on story sharing on front porches. Bayer once used cues from people’s yards — whether they kept a garden, had pets or posted political signs — to start conversations. Now, canvassers share personal stories about the pandemic to find commonality. Bayer, who has worked in factories, warehouses and as a delivery driver, begins his calls: ​“I’m Dan. I’m with Down Home North Carolina. We’re a community group. We work on building power for working folks. … We’re just calling folks to find out how they’re doing at the moment. … How are y’all doing?” 

Down Home’s counties also face recruitment efforts from active white supremacist groups. Overt white supremacy has been a dominant narrative throughout North Carolina’s history, says Todd Zimmer, a Down Home co-founder. ​“It’s been used as a wedge to prevent the emergence of common cause coalitions that are multiracial,” he says. ​“That typically looks like a white power structure fomenting and perpetuating the oppression of people of color. … A white supremacist political strategy disadvantages not only people of color but also all poor people because low-income folks, regardless of race, have a lot of shared concerns and issues.”

When Down Home’s Medicaid petition drive began in 2019, door-to-door canvassers gathered 1,200 signatures across all five counties. In Cabarrus County this fall, canvassers knocked on 1,559 doors and got 154 signatures. Since Cooper issued shelter-in-place orders March 27, canvassers have gathered 718 more across the counties as of press time. Their goal is 5,000.

Wright remains optimistic. Even phone calls can result in deep conversations, she says. One man, a 64-year-old African American business owner, told Wright he believed Covid-19 is a hoax. Wright shared how she just lost two friends to the virus. ​“I understand it’s not visible to you at this point in time, but I do believe it’s real,” she told the man. By the conversation’s end, he had shared his business’s struggles and what he was doing to help his neighbors, and agreed to electronically sign. He also gave Wright his email address to stay updated about Down Home’s work.