"Medicaid, which is the program that helps pay medical expenses for people under a certain income levels, … is a very big program. It’s an increasingly expensive program, and the unique thing in North Carolina is that counties have to kick in some of the money for Medicaid," he says.

"In the vast majority of other states, Medicaid is handled by the federal government and the state government, but locals don’t have to contribute. And in North Carolina they do," adds Dr. Walden, a North Carolina Cooperative Extension Service specialist.

"And this is an issue. You talk to county commissioners and others, and they will say this is one of the biggest issues they face because ... the expenses are growing -- and especially if you are in a lower-income county where you may have many folks on Medicaid, you just don’t have the resource base to meet those commitments.

"So there’s been talk for a number of years, and we are hearing it again in the General Assembly about, for example, maybe limiting the amount of contribution that counties make to Medicaid.

"Or there’s been some talk of some grand trade where the state will take over all of the state cost for Medicaid, including the local’s, in exchange for maybe taking back one of the sales tax revenue streams that the counties get.

We’ll obviously have to wait," he says, "and see what becomes of this."