By Rose Hoban
In 2012, semi-retired surgeon Jim Fulghum was elected to the North Carolina General Assembly to represent northern Raleigh suburbs in the House. As a freshman representative, Fulghum, a Republican, jumped into health policy with both feet and quickly rose in prominence at the legislature.
And that’s not unusual. For years, the North Carolina General Assembly has had multiple health care providers in its ranks on both sides of the aisle. Invariably, their expertise in medicine and experience with people cause them to rise up through the ranks quickly.
But with Fulghum’s death earlier this year and the departure of Rep. Mark Hollo (R-Taylorsville), a physician assistant who decided not to seek re-election, the ranks of actively practicing health care providers will dwindle.
One of those who remains is nurse Carla Cunningham of Charlotte, who is in a safely Democratic seat. Republican Bert Jones is a dentist who still practices, but Sen. Bob Rucho (R-Matthews) is retired from his dental practice.
And one of those health care providers will come from House District 41, which is one of the more competitive races in the state.
The district, which fills the southwestern corner of Wake County, stretching from Morrisville through western Cary and Apex down to New Hill, is a race between two health care providers: incumbent Tom Murry (R-Morrisville), a pharmacist and attorney, and Democratic challenger Gale Adcock, a nurse practitioner who runs the employee health care practice at Cary-based SAS. Adcock has also been on the Cary Town Council for a decade and currently serves as the interim mayor of Cary.
Because whoever holds the District 41 seat is likely to be a prominent voice on health care issues, we contacted both candidates and asked them the same set of questions about some pressing health care issues.
Their responses are edited for brevity.
What’s the value of having health care practitioners in the NCGA?
Murry: I think our founding fathers intended for a citizen legislature to be comprised of diverse individuals with diverse backgrounds. There’s a real shortage of health care professionals at the legislature. The value of a health care practitioner is the credibility when it comes to public-policy issues facing health care in our state.
The General Assembly is better off to have at least one pharmacist in it, and right now I’m the only one.
Adcock: There are a lot of decisions [in the legislature] that people make because of their own experience, or they hear only from one group, so it’s important to have someone in health care down there.
I’m a primary care practitioner in the trenches providing primary care to families. So if you have some health care issue in the building and someone else asks what does this mean to my constituents, [a health care provider] can tell you, or get you to the right person or information. I look forward to being a resource to my colleagues.
What have been the most important health care bills passed/not passed at the NCGA in the last biennium?
Adcock: In the Senate version of the latest budget, they had cut school nurses by 30 percent, and that’s happened every single budget. We should have a plan that over the course of so-many years we need to expand the number of school nurses to equal the national standard of one nurse for every 750 students. In many counties, we don’t even get close. Not having a plan to expand the number of school nurses is dangerous.
[pullquote_left]How much does each candidate have in his or her war chest? See our companion story. [/pullquote_left]They passed a bill in the [2014] short session, the handling of chemotherapeutic agents, to create rules that will have to be put into the Department of Labor to protect health care workers who handle [anti-cancer drugs]. But the bill doesn’t protect against a whole range of drugs that need to be protected against.Let’s talk about a bill that didn’t pass. In 2013, there was a bill that sought to increase access to prenatal and obstetrical services by certified nurse midwives. This is not a turf issue, it’s an access to care issue. We have counties where there are no obstetric services, no one to give prenatal care and deliver babies. The bill sought to remove the requirement for supervision so women would have access to care. That bill got through House committees in 2013, was calendared and got stopped and was sent to a study committee. That bill didn’t have time to make it through the short session. The legislature had all these other things going on that they couldn’t agree on. That great bill had bipartisan support and had good evidence to support it.
Murry: One of the pieces of legislature I worked on was a health insurance modernization bill to increase the amount of stop-loss coverage so small businesses could get help navigating the new requirements they face under the Affordable Care Act. The bill will help businesses insure and fund health plans for their employees under the Affordable Care Act without seeing the remarkable and dramatic premium increases we’re seeing because of the ACA.
I worked very hard on the autism insurance bill and that was a very rewarding process for me to work on. I would have liked to have seen that one get across the finish line.
Note: After it passed the House, the Senate never brought the autism insurance bill up for a vote.
Is there any health care issue you really want to move the needle on?
Murry: I think data, harnessing health care data in the Medicaid and State Health Plan, is crucial to improving overall population health. I’m not sure we do a good job of analyzing it and responding to the data and I’m not sure we get the data into practitioners’ hands in an efficient way so that it cam be used.
During my first term [2010-2012], I asked how many patients there were in Medicaid with diabetes, and I asked how many of those patients are at treatment goals, such as A1C levels [a long-term measure of blood sugar], cholesterol, blood pressure. I also asked how much would it cost us to get them to goal if they’re weren’t, and how much would it save us when they got there. That’s 1,000-level health care economist conversation, first-year graduate-degree work, and it was unanswerable.
I think we’re seeing progress with NCTracks, but I think there’s definitely more work to do.
Health care is not a partisan issue, but there is a difference between being in the majority and being in the minority. It’s a question to ask if there’s value in a health care provider in the minority that can’t get any legislation passed.
Adcock: As a nurse or a woman, I’m in the minority in almost every room I walk into. I have a good way with people, of hearing someone, finding the place they’re coming from, finding middle ground, doing the most good with the least damage, consensus building. I’m good at that stuff.
Even as a minority member in the legislature, I can display those behaviors and work with reasonable people in the legislature to take a different course on some of those paths that I find frightening in terms of long-term health care, things such as disparities. I feel like often people don’t understand that the decision of today is often a Band-Aid that in 10 years we’ll suffer from it. Our elderly, our children and most vulnerable have suffered in terms of bad policymaking.
Sometimes bad policy is simply a result of not enough information. I hope to bring more people into the conversation to make better policy.
What is your stance on women’s health issues, including abortion and birth control?
Adcock: As a nurse practitioner, I believe that women’s access to the full range of reproductive health care should not in any way be curtailed. It’s not up to the General Assembly to make decisions about women’s health care choices; it’s up to the women themselves to decide when and how to get that care.
Anything that diverges from that is a bad law, bad policy and bad precedent.
Murry: I don’t think abortion should be used as a form of birth control and I’d like to see us move towards making oral contraceptives available over the counter. But that’s not a state issue; that’s a federal issue.
Note: Murry voted in favor of HB 854 (2011), which imposes a 24-hour waiting period and mandatory ultrasound screening prior to obtaining an abortion. He also voted in support of SB 383 (2013), which would place restrictions on access to abortion.
What are your views on Medicaid expansion and the Medicaid budget?
Murry: When I was first elected, the question wasn’t whether Medicaid would be over budget, it was how many hundreds of millions of dollars would it be over budget. That was the conversation year after year. But this year, for the first time in a decade, Medicaid has finished in the black. That’s a substantial improvement from a fiscal responsibility standpoint.
We are in a different place as a state with Medicaid than we were 18 months ago, so I think it bears a second look at the cost implications of Medicaid expansion. I get the public-health discussion, but we’ve got to be able to pay for it, and I think we’re in a position to entertain that. There’s concessions being made on both sides; that will be the driver when it comes to Medicaid expansion. The driver on Medicaid expansion is how we can improve the traditional Medicaid program before Medicaid expansion will be a real conversation.
Note: Murry voted for SB 4 (2013), which restricted North Carolina’s ability to expand Medicaid.
Adcock: The state should have expanded Medicaid. It was a poor economic decision that’s put hospitals in jeopardy. People will not be able to get primary care, and there are more than 350,000 citizens that are not getting served.
The fact is that it was a poor economic decision as well as a poor health care decision.
How will you manage your day job when the legislature is so all-absorbing?
Adcock: I manage a $5 million budget and 58 employees; I know how to lead. I have a lot of flexibility in my job, and policy doesn’t happen 9 to 5. The General Assembly is “part time,” and I have the flexibility of coming into my job early or after adjournment. I’m not in that building every day now. I have teams that don’t have to have me physically present to function; I’m the chief health officer.
I also know I’ll still be making a difference for people even if I don’t get to Jones Street.
Murry: I helped to open a pharmacy inside Raleigh Neurology and I work there, but I’m not involved financially. I work there every Friday; they need someone one day a week. Other times, I do per diem work for other independent pharmacies. It fits the legislative schedule nicely. I can work when I’m available and my wife is also a pharmacist, and so between the two of us we keep the lights on.
It’s one of the luxuries of being a health care provider – in particular, a pharmacist. There’s a 24-hour, seven-day-a-week need for pharmacists.
I use my law degree as a judge advocate general in the North Carolina National Guard.
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