NC governor candidates on Medicaid, ACA, vaccines, other health issues

Pat McCrory, Roy Cooper and Lon Cecil, from left
Pat McCrory, Roy Cooper and Lon Cecil, from left

As part of an assessment of how the state is doing heading into a critical election Nov. 8, The News & Observer and The Charlotte Observer asked the candidates for governor about their plans for health care. Here are answers from Republican Gov. Pat McCrory and his challengers, Democrat Roy Cooper and Libertarian Lon Cecil.

Q: What’s your position on expanding Medicaid under the Affordable Care Act, and if you oppose it, what would you do about the estimated 500,000 North Carolinians who won’t have health insurance without the expansion?

Cecil: PPACA was touted as “universal healthcare” when it was passed by Congress and the U.S. Senate. ACA covered expanding Medicaid for the first two years, then transfers all of the expanded costs to each state. It was bait and switch to get votes from Medicaid recipients. Governor McCrory and the legislature were correct to not accept the unfunded program requirements. North Carolina will have increased demands from our existing Medicaid program, due to our aging and retiring population. Medicaid becomes the single-payer insurance for those qualified citizens, with North Carolina as the single payer.

Cooper: I believe accepting Medicaid expansion will provide a much-needed shot in the arm for our economy. It is inexcusable that Governor McCrory has refused federal dollars to expand Medicaid to many working people. Many Republican governors nationwide have said yes to health care for the working poor, but families are being left without a safety net because Governor McCrory is putting his partisan political agenda ahead of North Carolinians. Medicaid expansion will not only support essential services, it will create tens of thousands of good-paying jobs, help keep rural hospitals open, and help private employers keep their premiums lower.

McCrory: Roy Cooper has consistently supported expanding Obamacare, even though it has been an unmitigated disaster for North Carolina families and small business. He continued to defend Obamacare even while rates skyrocketed, patients were forced to give up their doctors and choices were reduced for consumers with Aetna leaving the marketplace. The President has refused to allow us to create a North Carolina plan. I have expanded Medicaid services for those who cannot help themselves, including those with Alzheimer’s.

Q: What reforms would you make to the state’s Medicaid program, if any, and if those changes are made, would that change your mind on whether to expand it?

Cecil: Federal recognition that state-paid Medicaid is an insurance plan for the citizens that are served.

Cooper: I believe North Carolina needs to reform cautiously instead of rushing headlong into the privatization of Medicaid coverage. Our Community Care of North Carolina is lauded as a national model for health care that is patient-focused and driven by collaboration between doctors and other medical professionals. Instead of abandoning the practices that are providing better care more efficiently, North Carolina should learn from its work and build on the success.

McCrory: One of our first challenges upon taking office was how to grapple with a Medicaid system that consistently overspent its budget by billions of dollars, jeopardizing investments in education and other priority areas. The system I inherited was not designed to improve the overall health of patients. In other words, we were spending more than $13 billion on a federally mandated program with little accountability or focus on results. When I took office, we discovered that the Medicaid budget had a $500 million mis-forecast, meaning the taxpayers were on the hook for much more money than expected.

Since 2013, our administration has been working diligently to stabilize our Medicaid program and work with the health care community to push for needed reforms to improve accountability and the quality of care. After finishing in the red for years, Medicaid is now in the black with a surplus, and the historic reform bill I signed in 2015 will help to improve patient care and hold down costs.

The state of North Carolina should see these reforms through regardless of the potential of future Medicaid expansion.

Q: How should the state increase access to nutritious foods in high-poverty areas?

Cecil: Sales tax waivers on small unincorporated vendors at “farmers markets,” so local growers can offer current fresh produce at minimum costs in high poverty or food desert areas. Encourage local government to clear tax delinquent property and assign the land to food co-op or community garden projects with five-year plan cycles.

Cooper: Food deserts are a serious problem in both urban and rural communities throughout our state. The challenge for families in these areas is that there are no supermarkets or grocery stores to purchase fresh and nutritional food. One solution with bipartisan support is to help equip local neighborhood stores to sell and store these items. We must also make sure that our schools offer quality, nutritional meals so that children have access to healthy fare no matter where they live.

McCrory: The problem of food deserts and access to nutritious foods is a unique challenge in our country, particularly in low-income and rural areas of the state. We are looking for ways to expand education of healthy eating and lifestyle choices, and I am committed to working with the legislature on opportunities to improve nutritional health so North Carolina’s children can reach their full potential.

Q: Should North Carolina eliminate its religious exemption to the requirement that children be vaccinated against disease?

Cecil: No. Vaccination is not 100 percent effective and is an invasion of person. State would be applying force to citizens that are too young to make their own informed decision, for something that was not proven essential to life. A child without vaccination would not be a risk to any vaccinated child, only perhaps to another child that was not vaccinated for the same reason.

Cooper: This is an issue where we need to be guided by science and facts instead of political agendas. Failure to vaccinate children leads to the spread of severe, preventable diseases. We should agree on a safe, effective schedule of vaccinations and encourage parents and caregivers to keep North Carolina healthy by vaccinating children and not allowing preventable diseases to spread.

McCrory: A bill to eliminate religious exemptions to North Carolina’s vaccination laws failed in the General Assembly last year after concerns were raised by parental and religious groups. This is an issue which brings about passion from both sides of the debate, but I am committed to upholding the laws of North Carolina as governor to ensure public health and safety.

N.C. Report Card

The News & Observer, the Charlotte Observer and McClatchy assessed the state of North Carolina as the Nov. 8 election approaches, with a particular focus on 20 measures of how the state is doing compared to previous years and compared to Georgia, Virginia and the rest of the nation. This week, a look at health in North Carolina.

Overall health ranking

North Carolina is below the median but has risen five places since 1990 in a ranking of states' overall health compiled by United Health Foundation based on analysis of behaviors, community and environmental conditions, policies and clinical care data.

Sources: American's Health Rankings, United Health Foundation


Infant mortality

North Carolina is following a national trend of a slow reduction of infant mortality but still trails the U.S. average. Virginia has made more progress in the past 25 years. (Chart shows deaths in the first year per 1,000 live births.)

Sources: U.S. National Center for Health Statistics, National Vital Statistics


Obesity rate

North Carolina's increase in the obesity rate has slowed recently, bringing it almost even with the national average and placing it between the averages in Georgia and Virginia. (Percentage of people with a body mass index of over 30.)

Source: Centers for Disease Control and Prevention


Primary care physicians

Slight gains across the board in the past 10 years leave North Carolina a little under the national average and its northern neighbor Virginia, in the number of primary care doctors per 100,000 people.

Sources: American's Health Rankings, United Health Foundation


Percentage uninsured

North Carolina's percentage of people without health coverage - once better than the U.S. average - is now more than two points worse. North Carolina, Virginia and Georgia have not expanded Medicare under the ACA.

Source: Bureau of the Census - Current Population Survey