shows a map of eastern NC with congressional districts in different colors
Congressional representatives in eastern North Carolina are selected from Districts 1, 2, 3 and 7. Map courtesy: GovTrack.us

Are you a health care worker? We’d love to hear from you. Email editor at northcarolinahealthnews.org

By Taylor Knopf, Tommy Goldsmith and Jacob Rosenberg

Health care is a central issue in this year’s midterm Congressional elections.

In a recent poll by the Kaiser Family Foundation, 71 percent of Americans said health care was a top issue; 30 percent said it was the single “most important” issue–a plurality. “It’s official: the 2018 midterms are about health care,” said the Wesleyan Media Project which tracks political ads nationally, announcing that nearly half of advertisements in federal races have mentioned health.

In eastern North Carolina, towns will need federal money for repairs after Hurricane Florence, approximately 500,000 Medicaid recipients in that part of the state will be watching the future of the Affordable Care Act (including the potential of a work requirement), and rural voters report they’re concerned about drug overdoses.

North Carolina Health News’ Voter Guide, through a series of eight identical questions sent to each candidate (either by phone or email or in person), will help give a clear picture of each candidate’s ideas and record on health.

The questions speak to not only the economics of insurance and Medicaid, but the many ways a candidate’s health policies will affect your life: strength of rural hospitals, food stamps, suicides, drug costs, drinking water, opioid use.

For ease of access, we’ve organized the responses into sections of the state: Eastern (NC 1, NC 2, NC 3, NC 7), Western (NC 11, NC 5, NC 10, NC 12), Central (NC 4, NC 6, NC 8, NC 9, NC 13); within those sections we’ve divided answers by district. Geographic designations are imperfect: District 1, for example, spreads from Durham to the Atlantic Ocean; we’ve included it in our Eastern section. To compare an issue across the state, each question is hyperlinked to a PDF. This document will include all answers to that question—across the entire state, across every district.

Despite multiple attempts (by phone, by email, by calling district offices, by going to offices in person), many candidates did not respond to multiple requests for a response. We’ve attempted to, through campaign materials and previous votes, cull together an idea of the policies of those on your ballot. If any candidate responds after this is published, we will add their answers.

 

However, NC Health News was not alone in having difficulty getting answers from candidates; it may be a countrywide phenomenon. Doug Hardy, a local newspaper reporter from Connecticut, told us 49 of 407 candidates filled out a survey. “Some candidates appear to be avoiding reporters entirely,” he said. “Of those I have looked at — as far as I can tell — our 12 % response rate is one of the best.”

Jiquanda Johnson, editor of the Flint, Mi. publication Flint Beat, said she was seeing the same thing for state and federal candidates.

“Last year, we had better results with local elections both mayoral candidates and city council saw the value in it,” she wrote. “We may not be able to go to print this year.”

Closer to home, Matt Leclercq, from the Fayetteville Observer, said “99 percent” of candidates responded to their voter guide, but many of those were local and county candidates.

North Carolina District 1

NC-1

G.K. Butterfield (Democrat, incumbent)

G.K. Butterfield (Democrat, incumbent)
Image credit: U.S. Congress

Butterfield supported the Affordable Care Act and, on his campaign website says, he “has also worked with his colleagues to introduce bills that would help expedite needed drugs to market, empower pharmacists to practice at the top of their state-issued license, and bring much needed resources to rural hospitals.”

Twenty percent of the bills he’s introduced have concerned health, according to GovTrack. In 2017, he introduced a bill to expand National Health Service Corps; in 2016, he wrote legislation which was eventually enacted for the Zika virus to be added to the FDA Priority Review Voucher Program; in 2009, he introduced a bill that was not enacted attempting to regulate pharmacy benefit managers.

“One of the proudest days in American legislative history was the enactment of the Affordable Care Act,” he said in a statement in 2017 opposing ACA’s repeal.

Question 1: What changes should Congress make to ensure the continuing financial viability of the Medicare and Social Security programs, especially now as many Baby Boomers are starting to retire and require services?

The Republican tax plan contributes to rising federal deficits, increases the federal debt, and makes it more difficult for our country to afford important safety-net programs.  I am deeply concerned that Congressional Republicans will seek cuts to Medicare, Medicaid, and Social Security to close a budget deficit of their own making. I will fight these assaults on North Carolinians’ health care and I will continue to call for bold action to lower health care costs.

Question 2: What do you see as the future of the Affordable Care Act? What should Congress do to ensure people have access to affordable health insurance that covers all their medical needs?

As a member of the House Energy & Commerce Committee, I was proud to have had a hand in writing the 2010 Affordable Care Act (ACA), which radically transformed our country’s health care system by ensuring coverage for over 20 million Americans who were not previously covered, including 35,000 people in North Carolina’s First District.  Sadly, there are those who appear determined to turn back the clock on health care and reverse the progress made under the ACA. I will always fight to expand access to care and ensure protections for those with pre-existing conditions. I support stabilizing the Affordable Care Act, increasing health care options for people in eastern North Carolina, fighting for better access to care in rural areas, and continuing to call for Medicaid expansion in our state which would make health coverage available to more than 650,000 North Carolinians.

Question 3: What needs to happen to ensure people living in rural areas have access to adequate health care, physicians and hospital services?

It is critical that we ensure people in rural areas have access to quality health care, which is why I helped reauthorize the Children’s Health Insurance Program and worked to strengthen Community Health Centers, which residents in rural areas rely on for many health care needs.  We also must ensure we have a health care workforce that can meet the needs of North Carolina’s communities, which is why I drafted and passed into law legislation to support loan repayment for health professionals in high need areas. I also strongly support the use of technology to bring health care to rural communities, which is why I have advocated to expand rural broadband access and telemedicine services.

Question 4: How do you think the country’s food stamps system is working? Any changes you’d push for?

The Supplemental Nutrition Assistance Program (SNAP) is our most effective anti-hunger program, helping 1 in 8 Americans — mostly children, seniors, or people with disabilities — put food on the table.  According to a January 2018 profile of SNAP households released through the U.S. Department of Agriculture, SNAP provided food benefits to a monthly average of more than 1.56 million North Carolinians in 2016.  I have and will continue to push for bipartisan support for critical programs such as SNAP, and I will fight proposals to cut funding for these programs. I also support expanding the use of SNAP benefits to include things like health care products.

Question 5:  Drug costs for regular Americans just keep rising. Do you have ideas for specific legislation to bring prices under control and/ or make pharmaceuticals more affordable for consumers? If so, what will it call for?

Congress must examine ways to encourage the development of new treatments including generic pharmaceuticals, biosimilar products, and alternatives to medication. I supported legislation to provide funding to the U.S. Food and Drug Administration, National Institutes of Health, and the National Science Foundation to research ways to reduce health care costs, including pharmaceuticals.  I also support looking at all areas of the drug manufacturing and supply chain to ensure that it is transparent, and prices are justified.  

Question 6: What should the federal government do to protect drinking water North Carolinians rely on from contamination by unregulated chemicals, in these and other locations? Is it time to re-examine the Clean Water Act, which is more than four decades old?

From pulling out of the Paris Agreement, to pushing reckless executive orders to undermine clean air and clean water, the Trump Administration has continuously threatened the health of our communities.  Forty-six years after passage of the Clean Water Act, I remain committed to protecting our environment and the clean water we rely on. As we saw from the tragedy in Flint Michigan, it is time to invest in our nation’s water infrastructure to ensure that people have clean water to drink.

Question 7: What measures would you support to reduce gun deaths, both accidental, intentional and those from suicide?

I support common sense solutions to reduce gun violence and I also support law-abiding individuals’ Second Amendment right to own firearms.  In Congress, I have advocated for a number of actions to keep dangerous firearms out of the hands of those who should not have access to them, including:

  • Require universal background checks on all gun sales and transfers;
  • Ban military style assault weapons and military high capacity ammunition clips;
  • Ban suspects on the terror watch list from purchasing firearms;
  • Call for the Centers for Disease Control (CDC) and the National Institutes of Health (NIH) to research gun violence as a major public health issue.

Question 8: What should the federal government’s response to the opioid overdose crisis Include? What could Congress do to reduce the amount of fentanyl coming through the mail from places like China?

For far too long, families in our region and across the country have suffered from the pain caused by the opioid crisis.  As a senior member on the House Energy and Commerce Committee, I am proud to have worked in a bipartisan fashion to combat the opioid crisis through passage of the 21stCentury Cures Act last Congress, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act passed in October, as well as the $6.7 billion included in the recent Defense-Labor-HHS appropriations package to address all sides of this crisis, from addiction prevention, to access to mental health services, to providing resources for law enforcement and families as they combat this crisis in their communities.

 

Roger W. Allison (Republican)

Roger W. Allison (Republican)
Photo credit: Roger Allison for Congress Facebook page

Roger W. Allison is a first-time political candidate and a Durham businessman.

According to his website, he’s “grown 8 healthcare and technology initiatives (1 IPO, sold 3, last has $42M valuation) and launched many startups.”

His stance on health care: “I pledge to embrace fiscal responsibility and to introduce new healthcare initiatives,” he writes; he told Ballotpedia one of his top three priorities is “Affordable healthcare insurance.”

He outlines in his “Pro-Family” promise that he’s 1) anti-abortion and 2) hopes to alleviate “healthcare insurance premiums for families of small entrepreneurs (1-4 employees)” by two-thirds by “includ[ing] the local adoption of primary care physician concierge programs coupled with major medical insurance for emergencies or hospital stays.”

He’s worked for the following health organizations, according to VoteSmart: Smartlink Health Solutions, Entrust Healthcare, MediClick, Baxter Healthcare.

Question 1: What changes should Congress make to ensure the continuing financial viability of the Medicare and Social Security programs, especially now as many Baby Boomers are starting to retire and require services?

Candidate did not respond to multiple requests for answers.

Question 2: What do you see as the future of the Affordable Care Act? What should Congress do to ensure people have access to affordable health insurance that covers all their medical needs?

Candidate did not respond to multiple requests for answers.

Question 3: What needs to happen to ensure people living in rural areas have access to adequate health care, physicians and hospital services?

Candidate did not respond to multiple requests for answers.

Question 4: How do you think the country’s food stamps system is working? Any changes you’d push for?

Candidate did not respond to multiple requests for answers.

Question 5:  Drug costs for regular Americans just keep rising. Do you have ideas for specific legislation to bring prices under control and/ or make pharmaceuticals more affordable for consumers? If so, what will it call for?

Candidate did not respond to multiple requests for answers.

Question 6: What should the federal government do to protect drinking water North Carolinians rely on from contamination by unregulated chemicals, in these and other locations? Is it time to re-examine the Clean Water Act, which is more than four decades old?

Candidate did not respond to multiple requests for answers.

Question 7: What measures would you support to reduce gun deaths, both accidental, intentional and those from suicide?

Candidate did not respond to multiple requests for answers.

Question 8: What should the federal government’s response to the opioid overdose crisis Include? What could Congress do to reduce the amount of fentanyl coming through the mail from places like China?

Candidate did not respond to multiple requests for answers.

 

North Carolina District 2

NC-2

George Holding (Republican, incumbent)

George Holding (Republican, incumbent)
Photo courtesy: Congressman George Holding/ Facebook page

George Holding represented the 13th District and then, with new district maps ordered by federal judges, moved to the 2nd District in 2017.

He’s expressed opposition to the Affordable Care Act. Post-elimination of the ACA, he says he wants to create “a system that rewards physicians who provide patients with quality care and makes insurance companies compete against each other to offer the most affordable, patient-centered options.” He voted, in 2017, for the House ACA replacement.

Holding voted to repeal money going to health centers that perform abortions and to allow Medicaid money to be used by opioid users for mental health treatment. He also voted for a series of changes to allow flexibility with health savings accounts (HSAs).

Question 1: What changes should Congress make to ensure the continuing financial viability of the Medicare and Social Security programs, especially now as many Baby Boomers are starting to retire and require services?

Candidate did not respond to multiple requests for answers.

Question 2: What do you see as the future of the Affordable Care Act? What should Congress do to ensure people have access to affordable health insurance that covers all their medical needs?

Holding said on an Oct. 22 Spectrum TV debate: “I voted to repeal Obamacare as many times as I was given an opportunity to vote for repealing Obamacare, I did it. Obamacare didn’t work.”

In addition, “I support protecting folks who have pre-existing conditions,” Holding said, according to the N&O.  “I don’t know of any policymaker in Washington that wants to prevent people with pre-existing conditions from being able to get health care.”

Question 3: What needs to happen to ensure people living in rural areas have access to adequate health care, physicians and hospital services?

Candidate did not respond to multiple requests for answers.

Question 4: How do you think the country’s food stamps system is working? Any changes you’d push for?

Candidate did not respond to multiple requests for answers.

Question 5:  Drug costs for regular Americans just keep rising. Do you have ideas for specific legislation to bring prices under control and/ or make pharmaceuticals more affordable for consumers? If so, what will it call for?

Candidate did not respond to multiple requests for answers.

Question 6: What should the federal government do to protect drinking water North Carolinians rely on from contamination by unregulated chemicals, in these and other locations? Is it time to re-examine the Clean Water Act, which is more than four decades old?

Candidate did not respond to multiple requests for answers.

Question 7: What measures would you support to reduce gun deaths, both accidental, intentional and those from suicide?

Candidate did not respond to multiple requests for answers.

Question 8: What should the federal government’s response to the opioid overdose crisis Include? What could Congress do to reduce the amount of fentanyl coming through the mail from places like China?

Candidate did not respond to multiple requests for answers.

Linda Coleman (Democrat)

Linda Coleman (Democrat)
Photo credit: Linda Coleman for Congress/ Facebook page

Linda Coleman has been a teacher, member of the General Assembly, and candidate for Lt. Governor, a race she lost twice, in 2012 and 2016, both times to Dan Forest.

Coleman is making health care a priority in her campaign: The first legislative point on her “About” page is that “she will fight to lower health insurance premiums.” She discusses increasing resources for rural hospitals to stay open and a “woman’s right to choose” on her website; and her ads include her saying she wants “to make sure that all of us have affordable, quality health care.”

Question 1: What changes should Congress make to ensure the continuing financial viability of the Medicare and Social Security programs, especially now as many Baby Boomers are starting to retire and require services?

Candidate did not respond to multiple requests for answers.

Question 2: What do you see as the future of the Affordable Care Act? What should Congress do to ensure people have access to affordable health insurance that covers all their medical needs?

Coleman said on an Oct. 22 Spectrum television debate: As for Medicare for all, I don’t know if that is the answer. I think that whatever program we can get to that lowers prescription drug costs and cover pre-existing conditions, that is what I will vouch for.

Question 3: What needs to happen to ensure people living in rural areas have access to adequate health care, physicians and hospital services?

Coleman didn’t answer our repeated calls and emails, but this statement is on her campaign website: “North Carolina’s rural areas are suffering from a lack of access to quality medical facilities. We have seen far too many rural hospitals declare bankruptcy and close in the past decade. Nobody should be forced to drive several hours away from their homes just to see a doctor. In Congress, I will do everything I can to provide the resources these hospitals need to stay open. We must improve infrastructure in these rural areas to make our hospitals more accessible to the people they serve. Finally, I will continue the fight to guarantee a woman’s right to choose what to do with her body.”

Question 4: How do you think the country’s food stamps system is working? Any changes you’d push for?

Candidate did not respond to multiple requests for answers.

Question 5:  Drug costs for regular Americans just keep rising. Do you have ideas for specific legislation to bring prices under control and/ or make pharmaceuticals more affordable for consumers? If so, what will it call for?

Candidate did not respond to multiple requests for answers.

Question 6: What should the federal government do to protect drinking water North Carolinians rely on from contamination by unregulated chemicals, in these and other locations? Is it time to re-examine the Clean Water Act, which is more than four decades old?

Candidate did not respond to multiple requests for answers.

Question 7: What measures would you support to reduce gun deaths, both accidental, intentional and those from suicide?

Candidate did not respond to multiple requests for answers.

Question 8: What should the federal government’s response to the opioid overdose crisis Include? What could Congress do to reduce the amount of fentanyl coming through the mail from places like China?

Candidate did not respond to multiple requests for answers.

 

Jeff Matemu (Libertarian)

Jeff Matemu (Libertarian)
Photo credit : Jeff Matemu For NC Second Congressional 2018 / Twitter page

Jeff Matemu is an immigration attorney.

His website does not have a health section, but he does mention decriminalizing marijuana.

Matemu has never had a tweet with the word “health” from his Twitter account.

Matemu lives in Fuquay-Varina. He’s originally from Kenya and there was a profile written about him from this angle.

Question 1: What changes should Congress make to ensure the continuing financial viability of the Medicare and Social Security programs, especially now as many Baby Boomers are starting to retire and require services?

Candidate did not respond to multiple requests for answers.

Question 2: What do you see as the future of the Affordable Care Act? What should Congress do to ensure people have access to affordable health insurance that covers all their medical needs?

Candidate did not respond to multiple requests for answers.

Question 3: What needs to happen to ensure people living in rural areas have access to adequate health care, physicians and hospital services?

Candidate did not respond to multiple requests for answers.

Question 4: How do you think the country’s food stamps system is working? Any changes you’d push for?

Candidate did not respond to multiple requests for answers.

Question 5:  Drug costs for regular Americans just keep rising. Do you have ideas for specific legislation to bring prices under control and/ or make pharmaceuticals more affordable for consumers? If so, what will it call for?

Candidate did not respond to multiple requests for answers.

Question 6: What should the federal government do to protect drinking water North Carolinians rely on from contamination by unregulated chemicals, in these and other locations? Is it time to re-examine the Clean Water Act, which is more than four decades old?

Candidate did not respond to multiple requests for answers.

Question 7: What measures would you support to reduce gun deaths, both accidental, intentional and those from suicide?

Candidate did not respond to multiple requests for answers.

Question 8: What should the federal government’s response to the opioid overdose crisis Include? What could Congress do to reduce the amount of fentanyl coming through the mail from places like China?

Candidate did not respond to multiple requests for answers.

 

North Carolina District 3

NC-3

Walter Jones (Republican, incumbent)

Walter Jones (Republican, incumbent)
Photo courtesy: Rep. Walter Jones / Twitter page

Longtime North Carolina congressman Walter Jones voted against the Affordable Care Act and many times to repeal it. But he also voted against the 2017 Republican ACA plan (the only NC Republican to do so); his full statement calls the bill rushed and lacking a CBO score.

He is currently a sponsor of a bill that says life begins at fertilization.

Question 1: What changes should Congress make to ensure the continuing financial viability of the Medicare and Social Security programs, especially now as many Baby Boomers are starting to retire and require services?

Candidate did not respond to multiple requests for answers.

Question 2: What do you see as the future of the Affordable Care Act? What should Congress do to ensure people have access to affordable health insurance that covers all their medical needs?

Candidate did not respond to multiple requests for answers.

Question 3: What needs to happen to ensure people living in rural areas have access to adequate health care, physicians and hospital services?

Candidate did not respond to multiple requests for answers.

Question 4: How do you think the country’s food stamps system is working? Any changes you’d push for?

Candidate did not respond to multiple requests for answers.

Question 5:  Drug costs for regular Americans just keep rising. Do you have ideas for specific legislation to bring prices under control and/ or make pharmaceuticals more affordable for consumers? If so, what will it call for?

Candidate did not respond to multiple requests for answers.

Question 6: What should the federal government do to protect drinking water North Carolinians rely on from contamination by unregulated chemicals, in these and other locations? Is it time to re-examine the Clean Water Act, which is more than four decades old?

Candidate did not respond to multiple requests for answers.

Question 7: What measures would you support to reduce gun deaths, both accidental, intentional and those from suicide?

Candidate did not respond to multiple requests for answers.

Question 8: What should the federal government’s response to the opioid overdose crisis Include? What could Congress do to reduce the amount of fentanyl coming through the mail from places like China?

Candidate did not respond to multiple requests for answers.

 

North Carolina District 7

NC-7

David Rouzer (Republican, incumbent)

David Rouzer (Republican, incumbent)
Photo courtesy: U.S. Congress

David Rouzer is a longtime political operative and, at age 42, an expert on rural and agriculture issues, holding the chairmanship of the Livestock and Foreign Agriculture Subcommittee.

Rouzer worked recently on the opioid crisis and a new primary care payment model (a bi-partisan legislation). Historically, he has been against the ACA and for the 2017 House replacement.

Rouzer’s introduced bills include: Sponsorship of a bill to cut back EPA regulation, a bill to drug test those on welfare.

Question 1: What changes should Congress make to ensure the continuing financial viability of the Medicare and Social Security programs, especially now as many Baby Boomers are starting to retire and require services?

Candidate did not respond to multiple requests for answers.

Question 2: What do you see as the future of the Affordable Care Act? What should Congress do to ensure people have access to affordable health insurance that covers all their medical needs?

Candidate did not respond to multiple requests for answers.

Question 3: What needs to happen to ensure people living in rural areas have access to adequate health care, physicians and hospital services?

Candidate did not respond to multiple requests for answers.

Question 4: How do you think the country’s food stamps system is working? Any changes you’d push for?

Candidate did not respond to multiple requests for answers.

Question 5:  Drug costs for regular Americans just keep rising. Do you have ideas for specific legislation to bring prices under control and/ or make pharmaceuticals more affordable for consumers? If so, what will it call for?

Candidate did not respond to multiple requests for answers.

Question 6: What should the federal government do to protect drinking water North Carolinians rely on from contamination by unregulated chemicals, in these and other locations? Is it time to re-examine the Clean Water Act, which is more than four decades old?

Candidate did not respond to multiple requests for answers.

Question 7: What measures would you support to reduce gun deaths, both accidental, intentional and those from suicide?

Candidate did not respond to multiple requests for answers.

Question 8: What should the federal government’s response to the opioid overdose crisis Include? What could Congress do to reduce the amount of fentanyl coming through the mail from places like China?

Candidate did not respond to multiple requests for answers.

 

Dr. Kyle Horton (Democrat)

Dr. Kyle Horton (Democrat)
Photo courtesy of Dr. Kyle Horton

An internal medicine physician, Kyle Horton is running on health care and environmental health. She’s framed her campaign as a doctor fixing an issue. For, example: “Dr. Kyle’s Rx For Congress.”

On health care, Horton said she believes Americans have a right to quality health care, supports universal coverage, will push for Medicaid and Medicare expansion, and wants to “recognize addiction as a public health issue (not a moral failing or a crime) and invest in prevention, treatment, and recovery programs.”

Horton has been profiled as part of a group of doctors running for Congress as Democrats by Kaiser Health News. And she was a VA physician for a bit.

Question 1: What changes should Congress make to ensure the continuing financial viability of the Medicare and Social Security programs, especially now as many Baby Boomers are starting to retire and require services?

As an internal medicine doctor who has cared for seniors throughout my career, I understand that we must protect and actually expand both Medicare and Social Security, which have not kept up with the needs of our seniors and their cost of living. Contrary to what many think, it’s important voters realize that the Affordable Care Act (ACA) had actually extended the solvency of Medicare to 2038. In fact, we will need to put back several of the taxes that were recently cut by the GOP on the wealthiest corporations, including the big insurance and pharmaceutical companies, in order to ensure that Medicare doesn’t go broke with the debt crisis created. Hardworking Americans should be able to rely that after they paid into these programs, they will be around for the future—in order to do that we will have to adjust the payroll tax to keep pace with inflation and scrap the cap on Social Security income tax limits to ensure that everyone pays their fair share, and our seniors can retire with dignity and security.

Question 2: What do you see as the future of the Affordable Care Act? What should Congress do to ensure people have access to affordable health insurance that covers all their medical needs?

We should work to improve the Affordable Care Act and strengthen it based on what we learned from the issues in implementation. Unfortunately, after 7 years of a dialogue to repeal and replace the ACA by leaders in Congress, we’ve learned that there was no plan. As a doctor, I understand that every American deserves quality health care. We should strengthen the ACA by gradually expanding Medicare — first by lowering the eligibility age to 50, then by creating a public option for anyone who wants to buy in, and then move to making Medicare available to anyone who chooses it. In the Southern states, like North Carolina, where leaders chose not to expand Medicaid, because they put partisan politics over people’s lives, we should federally expand Medicaid with a regional marketplace. This would ensure that we have a safety net to cover the most vulnerable Americans — including our seniors, kids, and the disabled. By expanding Medicare and Medicaid incrementally, we can better invest in preventive care, protect those with pre-existing conditions, and address skyrocketing drug costs by collectively negotiating drug prices. This unified public safety net system would allow price transparency, accountability, and more health care choices.

Question 3: What needs to happen to ensure people living in rural areas have access to adequate health care, physicians and hospital services?

Our rural hospitals are disproportionately dependent on Medicare and Medicaid, as our population is aging and economies have not grown with good-paying jobs in much of rural America. Unfortunately, as Washington politicians have gutted Medicare and Medicaid, including cutting back on provider reimbursements, many of our rural hospitals are threatened financially. I’ve also worked in emergency care, and know how important it is to have rural hospitals and emergency rooms open—accidents are a leading cause of death in rural America because of distance to care. We must strengthen Medicare and Medicaid, as well as provider reimbursement in rural America so that providers continue practicing in medically underserved areas. We should allow student loan forgiveness and invest in scholarships and training opportunities for those who choose to practice in rural areas. I also support direct federal protections and block grants to maintain access to emergent care, evidence-based burn care, and other safety net care because every American deserves quality health care no matter where they live.

Question 4: How do you think the country’s food stamps system is working? Are there any changes you would push for?

The political games that are played around food stamps need to stop, because there are many seniors, disabled Americans, veterans, and kids going hungry as they are caught in the crosshairs of a deceptive dialogue about food stamps. Recent proposed changes and reforms would have risked millions of Americans food assistance, and many kids would no longer have qualified for free and reduced-price school meals. While the dialogue around reform and work requirements sounds good, it actually would’ve created a state-run training bureaucracy under the Supplemental Nutrition Assistance Program (SNAP) that’s costly and that’s never been proven to move people out of poverty. We need to address waste and fraud, no question, but also we need [to] understand that SNAP participation is linked to being healthier—lowering health care costs and improving health outcomes for individuals in poverty. Always remember that food stamps are a tremendous stimulator of our economy—every $1 investment generates $1.70 in economic activity. To improve food stamps, we should be innovating to link recipients with healthier and locally-sourced agriculture, including at farmers markets which would also provide business to protect smaller family farms.

Question 5: Drug costs for regular Americans continue to rise. Do you have ideas for specific legislation to bring prices under control and/or make pharmaceuticals more affordable for consumers? If so, what will it call for?

As a doctor who’s worked in primary care, I’ve had to think every day about whether or not my patients can afford their medications. In any given year, about one third of Americans won’t fill a prescription because of the cost. I believe every American deserves quality health care that they can afford, including prescription drugs. I support expanding Medicare and Medicaid, and using the collective power of this system covering millions to negotiate better prices so we get the best deal as taxpayers. I support allowing the importation of safe drugs from Canada, and prohibiting trade deals that would raise drug prices or extend the monopoly period when a brand name drug company has no generic competition. I would support federal legislation to protect research and development for orphan drugs, and that would stop pay-for-delay schemes that enable one manufacturer to pay others not to manufacture generics, which extends their monopoly beyond the patent. To rein in the power of the biggest pharmaceutical companies, I would also require price transparency and accountability so that Americans will know the true cost of research, development, and running clinical trials which would enable us to protect Americans from crooked price gouging.

Question 6: What should the federal government do to protect drinking water North Carolinians rely on from contamination by unregulated chemicals, in these and other locations?  Is it time to re-examine the Clean Water Act, which is more than four decades old? Should the law be restructured? What are your ideas, if any, for updating these environmental statutes?

Having graduated high school in Flint, Michigan and living in Wilmington, I’m both personally and professionally committed to using my medical and public health expertise to clean our water. No kid should ever be a guinea pig at the hands of a Fortune 500 polluter. With chemicals like Gen X also in fire fighting foam and contaminating water around military bases, we need federal legislation to investigate health consequences of these emerging contaminants, and to regulate their clean up. It’s time to re-examine the Clean Water Act to address growing challenges from climate change, failing infrastructure and to reflect the latest threats from big polluters. We should defend the Waters of the United States Rule to protect smaller streams, lakes, and creeks that are sources of our drinking water. I’ll fight efforts to defund and dismantle the EPA that have been championed by my opponent who funds his campaigns with big polluter and fossil fuel money. I would support expanding participation in the Centers for Disease Control’s Environmental Public Health Tracking Network which enables the public and county public health departments to track trends and figure out the burden of disease being caused by toxins in our environment.

Question 7: What measures would you support to reduce gun deaths, both accidental, intentional and those from suicide?

Tragically, I nearly lost patients to suicide while awaiting care within the Veterans Affairs health care system. This is why I worked on suicide prevention, particularly for veterans, which is a public health crisis claiming an estimated 20 veteran lives a day. There’s a growing body of research that means matter—access to firearms and other lethal means must be addressed proactively to save lives. From a public health standpoint, gun violence in this country is a crisis, including in our schools. We must fully repeal the Dickey Amendment that prevented the research we need to better understand gun violence, and also fund that research fully. As a gun owner, I support what I believe was the true intent of the Second Amendment to protect a “well-regulated militia” that’s armed against tyranny. To keep us safe though, we need common sense gun policies that put people’s lives over gun manufacturers profits. I’m with the majority of Americans who endorse strengthening universal background checks, closing gun show and internet sale loopholes, as well as addressing weapons and their accessories that were designed for combat that have no business in the hands of untrained civilians and that are unnecessary for hunting or personal protection.

Question 8: What should the federal government’s response to the opioid overdose crisis include?

Opioid addiction and overdose deaths are a public health crisis, and we need a comprehensive plan to save lives. With expertise as a prescriber whose seen the benefits of opioids for patients, I worked on federal opiate safety legislation that passed and that has effectively reduced deaths and improved pain management within the Veterans Affairs health care system. We need to end the stigma that keeps folks from getting needed care, enforce federal mental health and substance abuse parity, and protect those with pre-existing conditions. We need to expand Medicaid, which covers roughly one fourth of mental health and one fifth of substance abuse care. The federal government should invest in Law Enforcement Assisted Diversion programs and make opioid reversal agents, like Narcan, readily available to first responders so we can save lives, while knowing that we can’t arrest our way out of a drug crisis. We need to incentivize provider education on safe use of opioids and invest in better nationwide tracking and reporting systems to identify trafficking. Federally, we also need to ensure evidence-based, medication-assisted treatment for addicts is available in underserved and rural areas. It’s also time to hold the biggest pharmaceutical companies accountable who’ve contributed to this crisis.

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Rose Hoban

Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...