Opinion: Medicaid key to state of this county

Gov. Mike Easley’s State of the State address offered much to cheer and much to jeer, but the most important thing for Vance County may have been a word he never used: Medicaid.

Let’s put aside all of the rhetoric about one North Carolina and how wonderfully the Tar Heel State is doing after four years of the Easley administration. We in Vance County know that none of that good news applies to us.

Those 83,000 new jobs the governor touted didn’t come here, and while the rest of the state may be enjoying an economic rebound and an unemployment rate below the national average, Vance County has a stranglehold on the title of Unemployment Capital of North Carolina.

The More at Four prekindergarten program hasn’t made much of a difference here for the simple reason that the Vance County school system already was spending federal Title I money to put at-risk 4-year-olds in school a year early.

The governor’s “smart, targeted investments to take advantage of major business opportunities” have either done nothing for us (see the $242 million Dell boondoggle, which benefits Forsyth County, whose jobless rate is one-third of Vance’s) or hurt us (remember Easley at the groundbreaking for the massive U.S. Tobacco processing plant in Nash County, whose construction led to the demise of the company’s J.P. Taylor plant and its 400-plus jobs in Henderson).

And let’s not get into the debate about a lottery right now (for what it’s worth, we at Home in Henderson are against it).

Instead, let’s look at the heart of Easley’s speech Monday night, education.

“We must raise our high school graduation rate dramatically and quickly,” Easley told the General Assembly. “We have great universities, great community colleges, early childhood and now great elementary schools. There is no excuse not to have great high schools too.”

He said too many ninth-graders aren’t graduating on time, and that comment hits home: Vance County, which had the highest secondary school dropout rate in the state in 2001-02, still has a serious dropout problem. According to statistics released this month by the state Department of Public Instruction, Vance had a dropout rate of 6.68 per 100 ninth- to 12th-graders in 2003-04 (11th-highest out of 117 school systems in the state), compared with 4.86 per 100 statewide, and 4.74 per 100 seventh- to 12th-graders (11th-highest in the state), compared with 3.29 per 100 statewide.

What’s Easley’s solution? Give those high-schoolers the chance to pick up an associate’s degree, normally a two-year process, if they spend an extra, 13th year in high school. The idea has a catchy name, Learn and Earn, and is based on a sound concept, connecting classwork with a paying job.

But if students aren’t willing to hang on for 12 years of school, why should we think they’ll agree to stay for 13 years?

Easley’s other big education initiative is a pledge to fully fund the state’s formula for low-wealth schools, “an increase of over 50 percent,” to meet the state’s constitutional responsibility to give all children an equal chance at a sound, basic education. That’s good news for Vance County, one of the lowest-wealth counties around, although it’s not clear how much more Vance will get. The Public School Forum of North Carolina estimated in 2003 that the state shortchanged Vance by $1 million, but the state gave Vance an extra $2 million this school year in response to the Leandro lawsuit.

Also unclear is how Easley’s plan to combine all funds for at-risk children into one program with high accountability will play out.

What is clear is that Easley has no intention of doing the one thing that would do the most to aid education in low-wealth counties: end the Medicaid burden.

North Carolina is one of two states (along with New York) that force counties to share the costs of Medicaid, the federal-state health program for the poor. The program is designed as a 50-50 split between the federal and state governments, but North Carolina makes each county contribute to the state’s share. Each county must pay a percentage of the Medicaid expenses in that county.

Medicaid expenses are proportionally higher in low-wealth counties, which naturally have more poor people who qualify for the public health program. Thus, Medicaid consumes a much bigger chunk of the county budget in Vance than in a wealthy county, such as Orange.

That means that if Vance and Orange had the same per-capita revenue, Vance would have far less to spend per student because it would be spending so much more on Medicaid. (In fact, based on the tax base, Vance puts more of what it can afford into education than Orange does, according to the Public School Forum.)

Want to level the playing field between Vance and Orange? The first, biggest step is to relieve Vance of the rocketing cost of Medicaid. That would allow Vance to put more money into teacher recruitment, training and retention while actually cutting one of the state’s highest property tax rates, making Vance a more attractive place to live for teachers and the rest of us.

So if the governor truly wants to create one North Carolina, he needs to push for one North Carolina funding source for Medicaid: the state government.

Conveniently, Easley and legislators already are kicking around proposals for the perfect source for the money the state would need to assume the full Medicaid burden: a higher cigarette tax.

Proponents say the tax is a health care measure because it could reduce smoking by cash-strapped teens and anyone else with a limited amount to spend on cigarettes. That health advantage might be true, but more certain is that the higher cigarette tax would produce hundreds of millions of extra dollars for the state. Spending that money on Medicaid would ensure that the higher cigarette tax would benefit health care, and because better-educated people are less likely to smoke, the educational value of relieving the counties of the Medicaid burden also would lead to a healthier North Carolina.

Here’s hoping our local legislators insist that a higher tobacco tax and Medicaid reform go hand in hand.