“Obviously we don’t participate in what goes on with the Trump administration,” said Haywood County Board of County Commissioners Chairman Kirk Kirkpatrick. “But what we have to do is react to the decisions that are made by the federal government.”
Those decisions have already sparked controversy throughout Southern Appalachia, a region so poverty-laden that myriad federal programs have been created to address basic economic needs over more than half a century.
Retired pediatrician Dr. Stephen Wall brought his concerns to the county April 3 in the form of a resolution presented during the public comment portion of the regular board meeting.
Wall, who practiced in Haywood County for 28 years, said that over 4,000 people in the county have health insurance thanks to the Affordable Care Act and an additional 4,000 children are insured through Medicaid or the Supplemental Children’s Health Insurance Program, also known as Health Choice.
“I’ve had over 120,000 patient encounters, so I speak with some experience about what people go through in this county,” Wall said, adding that more than half the children he’s seen are on Medicaid or Health Choice. “With the current threat of cutting these programs, along with many other socially beneficial programs, there’s this real sense of jeopardy that people are feeling in this county — people who really are some of our neediest citizens.”
Wall’s resolution also mentions that the termination of or dramatic reduction in funding to these and other federal programs like home heating assistance and Meals on Wheels would possibly cause “irreparable harm and even death” to thousands of county residents.
“When I think about these cuts,” said Patsy Davis, executive director of local social service agency Mountain Projects, “I think about a mission trip I went on to a third-world country. Every one of these items prevents us from becoming a third world country.”
Davis said seven programs administered by Mountain Projects face complete defunding, which would slash her budget by $2 million from its usual $13 million.
“I estimate at minimum 3,000 people would be affected,” she said, referring to people who take advantage of the foster grandparents program, the senior companions program, weatherization and LIHEAP services, a high-school dropout prevention initiative and self-help housing.
“Most of them are working people, holding down low wage jobs and can’t afford medical insurance, or their employers don’t offer medical insurance,” Wall said. “Their children are reliant on these programs and the idea of an $800 billion cut in Medicaid over the next eight to nine years is to me absolutely immoral and unconscionable, no matter what system — Christian or Judaic — you hold to.”
Wall said he’s taken these concerns to Congressman Mark Meadows, R-Asheville, many times.
“I would say he is indifferent,” Wall said.
Calling Meadows “indifferent” doesn’t accurately portray his stance, as it suggests an ambivalence that simply isn’t there; Meadows is actively opposed to this form of socialized medicine, instead suggesting health care could be made more affordable by implementing “cost control” measures that have failed to gain traction in the past, like tort reform.
“I feel that our county commissioners need to go on record to our elected representatives, especially Congressman Mark Meadows,” Wall said.
Haywood County Commissioner Brandon Rogers acknowledges Wall’s apprehension, but says he stands with Meadows on both the budget and on health care.
“There are some concerns, however I support the administration and the decisions that they’re making,” said Rogers, who is one of two Republicans on the board.
Trump’s proposed cuts resonate well with those who hold that providing subsidized health care and funding organizations like the Appalachian Regional Commission, the Corporation for Public Broadcasting and the Environmental Protection Agency should not be core functions of the federal government.
Prior to the Affordable Care Act, Americans — especially the working poor — found the invisible hand of the health care market digging in to increasingly empty pockets, and everyone from Meadows to Kirkpatrick agrees something needs to be done.
“Unfortunately there’s a need to provide health insurance for children and the elderly,” Kirkpatrick said. “What happens is, they look to the county to try to take care of some of those issues, so it could be something we have to be concerned about.”
That concern affects Davis’ Mountain Projects as well; she said that health care cuts would only mean more clients clamoring for Mountain Projects programs.
“These cuts target the most vulnerable in our society,” she said.
The resolution as presented by Wall may never receive formal consideration, not that it might sway state legislators even if it was passed.
Previous county resolutions to Sen. Jim Davis, R-Franklin, Rep. Mike Clampitt, R-Bryson City and Rep. Michele Presnell, R-Burnsville, that had advocated for an increased room occupancy tax and a change in how the county’s tax collector is employed both fell on deaf ears earlier this year.
If nothing else, Wall’s resolution was symbolic in calling for Haywood County’s national and state reps to “oppose any cuts in health care and other critical programs for the residents of Haywood County” and “fix the shortcomings of the ACA” without abolishing it completely.
“I don’t think there’s any perfect system,” Wall said. “Certainly Medicaid, the Affordable Care Act and Medicare all have their problems, which can be fixed. If you look at other countries, we are the only developed country in the world — of the 20 leading industrialized countries — that doesn’t have universal health care for all its citizens. How can we justify that? The bankruptcy distress, the anxiety this causes citizens is something that can be dealt with. It’s unnecessary and it’s cruel.”