GEOFF BENNETT: Staying on the topic of health care access, this week, North Carolina became the latest in a growing number of states to expand Medicaid under the Affordable Care Act.
Governor Roy Cooper signed the bill into law Monday, marking a major victory for Democrats in their efforts to expand federally assisted health care coverage to low-income Americans.
ROY COOPER (D-NC): The strength of our communities depends on the health of our people.
And today is a historic step toward a healthier North Carolina.
When this law takes effect, it'll make health care accessible for more than 600,000 North Carolinians.
GEOFF BENNETT: Expanding health care access has gained support among voters.
The latest "PBS NewsHour"/NPR/Marist poll shows 63 percent of Americans believe it's the government's responsibility to ensure health care coverage to Americans.
For more on this latest investment in Medicaid access, we're joined by North Carolina Secretary of Health and Human Services Kody Kinsley.
Secretary Kinsley, welcome to the "NewsHour."
KODY KINSLEY, North Carolina Secretary of Health and Human Services: Great to be here.
GEOFF BENNETT: North Carolina is expanding Medicaid to adults who make up to 138 percent of the federal poverty level.
So that would be about $41,000 for a family of four.
You have been traveling the state talking to people who would benefit from this expanded access.
What are you hearing and what are you seeing?
KODY KINSLEY: People are really excited.
First, I want to just thank the governor for building such a broad coalition of people that have worked so hard over the last decade to get us to where we are today.
But, in the last few years, some things have changed.
First and foremost, the additional payments from the Biden administration to really incentivize states to join Medicaid changed the conversation.
And then also seeing people experience the mental health crisis that were in this country today has made people realize that we have got to have every tool at our disposal, and there's no tool that would change the game for mental health in North Carolina more than Medicaid expansion.
GEOFF BENNETT: To your point about that, across the country, mental health care centers, across North Carolina, many of them have closed, and it's jails that ended up becoming mental health care facilities.
Tell me more about your plan to invest in health care.
KODY KINSLEY: Well, we want to invest using those signing bonus dollars for Medicaid expansion, a billion dollars to try to rebuild capacity in a mental health system that we know has languished for far too long.
And we have got to take the resources to where the people need it; 60 percent of people in incarcerated settings have a substance use disorder, many of whom have a co-occurring mental health illness.
If people had those sorts of rates of diabetes or any other disease, we would know that there's a problem with that system.
So we want to invest in pre-arrest diversion, jail-based treatment programs, reentry programs that break this costly cycle that we know our local communities bear the brunt of.
We need health care, and not handcuffs.
And that's something that we have heard firsthand from sheriffs all across North Carolina, as we have been battling the opioid epidemic.
We're not going to arrest ourselves out of these issues.
If we give people health care, divert them to treatment, give them a path to recovery, we not only heal themselves.
We get to support them in healing their families and their communities.
This is the right path forward.
And targeting our work in the justice system is a smart investment.
GEOFF BENNETT: You know, when you say that the conversation around expanding Medicaid has changed, I spoke with Phil Berger, the North Carolina Republican Senate leader, on this program some weeks ago.
He initially objected to Medicaid expansion in North Carolina, had a change of heart.
He now says it makes perfect sense.
There are still some folks who have some questions about the cost, to include Donald Bryson.
He runs the North Carolina-based John Locke Foundation, and he had some issues with the overall price tag.
DONALD BRYSON, John Locke Foundation: The problem is, how much is this going to cost us in the long term?
What's the woodworking effect of Medicaid expansion in North Carolina?
How much is this additional hospital bed assessment going to cost taxpayers in North Carolina?
These are all questions that are unanswered, but it seems like we're betting everything on one-time $1.8 billion funding.
GEOFF BENNETT: So what about that?
What about the cost?
And what's the plan to prevent cost overruns?
KODY KINSLEY: You know, I would have loved for us to expand Medicaid a long time ago.
But the advantage of going this far down the path is, we have got a lot of other proof from other states.
We see that Medicaid expansion helps control costs for health care and helps save rural hospitals.
And we know that the federal government is committed to maintaining the 90/10 match.
The plan that we have worked out to have our hospitals pay for that 10 percent match, this is cost-contained.
This is a smart investment.
And people -- right now, we pay for this care for people, no matter what, when they end up in the emergency department with a stroke or a major cardiovascular event.
Reaching them at a point of prevention and getting them on preventative care is a lot cheaper.
This is not only a smart investment for resources.
It's going to make a large difference over time.
GEOFF BENNETT: It's been more than a decade since the Supreme Court ruled that states did not have to accept Medicaid expansion under the Affordable Care Act.
Nearly half of the states opted out; 40 states now have it.
But what has that meant for working-class North Carolinians, for seniors, for folks who live in rural areas to have not had expanded access to health care for more than a decade?
KODY KINSLEY: I grew up in North Carolina, and I grew up without health insurance.
I know firsthand what it's like to have family members try to decide whether they're going to buy food or they're going to see the doctor, parents praying that their arm is just hurt or sprained, not broken.
These are -- my story, like these other 600,000 stories in North Carolina that will benefit from expansion, have been heartbreaking day by day.
This last decade of waiting has meant that some of the people who started on this journey with us are no longer here because they have lost their lives.
I mean, this is the right thing to do.
And I'm glad that we are doing it now.
And I hope that we can continue to invest in people, because they are our greatest strength in North Carolina.
GEOFF BENNETT: Kody Kinsley is the secretary of health and human services for the state of North Carolina.
Thanks for being with us.
KODY KINSLEY: Thank you.