Republicans favor changes that rely on market forces. Democrats see government continuing to play a major role, with gains in health insurance coverage coming from the expansion of existing programs such as Medicare and Medicaid. It can seem like they're not talking about the same problem.

We asked Adam Searing, a health policy expert with the N.C. Justice Center, for help navigating the candidates' health-care plans. His group seeks affordable health care for all residents of the state.

Q: Do elected leaders have much ability to affect the cost and availability of health care?

A: Yes, they have huge influence. Elected leaders could ensure coverage for almost everyone, and they could do it almost immediately. All it requires is political will, and that hasn't been there.

Q: What sort of changes can be made at the state level, and what has to come from the federal level?

A: States can do a lot, actually. We can use state dollars to subsidize premiums for small businesses. We can expand existing programs (such as Medicaid or N.C. Health Choice for Children) to cover more people. We could limit health insurers' ability to charge more if a person is sick. The state could make great strides, but we'd need the federal government's help to finish the race.

Q: What strategies do you hear the Democrats and Republicans talking about?

A: At the state level, Democrats are talking about helping specific groups, such as small businesses and parents of children who qualify for public health insurance. At the federal level, Democrats talk about achieving close to universal health insurance coverage using a mix of public and private programs. Republicans at the state and federal level talk a lot about putting more responsibility on the consumer. You hear a lot more about high-deductible health plans, tax credits and tort reform. There's a lot more interest in giving individuals some money (instead of offering coverage through a job) and letting them buy their own plan.

Q: What advice can you give voters in assessing candidates' proposals?

A: Voters should look very carefully at what is being proposed. Every candidate says they're for affordable coverage for everybody. But the devil is really in the details. How would the plan work if you are sick? Would an older parent (not yet eligible for Medicare) be able to get affordable coverage? One question I like to ask is: "Would the candidate drop whatever health coverage they have now and enroll in the plan they are proposing?"

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