Ashley Bell is a physician associate and educator in Winston-Salem. For 15 years, she has worked in emergency departments, primary care offices, rural clinics and telemedicine treating patients.
Candidate Q&A
Answers provided by email.
What do you see as the biggest financial and administrative challenge to implementing the work requirements for Medicaid that were included in the One Big Beautiful Bill?
The paperwork is the problem. Most people on Medicaid who can work already do. Now every one of them has to prove 80 hours a month, and somebody has to build the system, hire the staff and chase the forms. That costs money, and the state and counties are stuck with the bill. The people who lose coverage won’t be the ones who aren’t working. They’ll be the ones who never got the letter, or whose employer didn’t send the hours in. Then they show up at the ER anyway, and the hospital eats it. In North Carolina, more than 600,000 people are covered through expansion. I’d work to repeal this. If it stays, I’d push for the widest exemptions and automatic data matching so people aren’t punished for a clerical error.
What would be your plan for ensuring the future security and strength of Social Security and Medicare?
Social Security is a promise we made, and I won’t cut it. The trust fund shortfall is fixable. Right now, income above about $184,000 isn’t taxed for Social Security at all, so the janitor pays on every dollar and the CEO doesn’t. Lift that cap and the math gets a lot friendlier. For Medicare, I’d expand drug price negotiation, stop overpaying Medicare Advantage insurers, and go after private equity firms that buy up care and strip it for parts. I’ve sat with seniors deciding between insulin and groceries. Nobody in that room was gaming the system. They paid in their whole working lives, and they should get what they were promised.
What would you support in Congress as a plan to help control health care and pharmaceutical costs?
Insurers shouldn’t be overruling clinicians with prior authorization denials, and nobody should go broke because of a hospital stay. In Congress I’d expand Medicare drug price negotiation, extend the $35 insulin cap to everyone, rein in pharmacy benefit managers, extend the ACA subsidies and require hospitals and insurers to post real prices. Long term, I support Medicare for All. We spend a huge amount of money on administrative overhead, and a single system would cut most of it. I’ve worked in this business for 15 years, and I can tell you the people who profit from the confusion are not the patients.
What steps would you take to improve access to health care in rural areas? How do we make the Rural Health Transformation Program successful in North Carolina?
Rural hospitals are closing because they treat a lot of Medicaid and uninsured patients, and Washington keeps cutting what they’re paid. So step one is protecting Medicaid. Then we need more people: loan repayment and training for nurses, PAs, and primary care docs who’ll stay in small towns. Telehealth only works if you have broadband, so that has to get finished too. For the Rural Health Transformation Program to work in North Carolina, the money has to reach the clinics and hospitals, not stall with consultants and software vendors. I’d want local input, public reporting on where every dollar goes, and funding for actual staff. It also can’t be a consolation prize for the Medicaid cuts.
The rollout of AI is moving fast, including in health care, and leaders in that space are calling for things to slow down. What federal moves should be taken to regulate it, if at all?
I’m not against it. AI can help with charting and catching things early, and God knows clinicians could use less paperwork. But a wrong answer in medicine can kill someone, so there have to be rules. I’d want FDA testing before and after these tools go into use, a real clinician accountable for every decision, and a flat ban on insurers using AI to deny care automatically. Patients should be told when it’s being used on them, and their data needs real protection. I’d also oppose any federal move that blocks states from setting their own rules. If we don’t set the guardrails, the companies selling the product will gladly do it for us.
Where do you stand on federal vaccine policy? What should be done to prevent future disease outbreaks?
Vaccines work. I say that as a clinician who has seen what the diseases do. Federal policy should follow the science, set by independent experts at the CDC and FDA, and not by whoever’s in the White House. I’d restore funding and credibility to those agencies, and keep vaccines covered and free through Medicaid, insurance, and Vaccines for Children. To prevent outbreaks, we need disease surveillance, a public health workforce that doesn’t get laid off every budget cycle, and local health departments funded year-round. Pandemic prep is like a smoke detector. Nobody notices it until the day it matters, and by then it’s too late to install one.
We’ve had some high-profile food contamination outbreaks, yet the federal government is pulling back on regulation of food, air and water. What level of federal regulation do you support and why?
I support strong federal standards. Contamination doesn’t stop at the county line, and nobody can test their own groceries or tap water. Most of us have never had to wonder whether dinner is safe, and that’s because of rules some folks call red tape. Cutting inspectors doesn’t save money. It pushes the cost onto hospitals, farmers, and families after something goes wrong. I’d fully fund enforcement at the FDA, USDA, and EPA, and I’d make sure small farms and businesses get technical help to comply, because most of them want to do it right. A good rule protects the honest operators from the ones cutting corners.
PFAS contamination is a nationwide issue; how do you address it while balancing public safety and business interests?
The polluter should pay for cleanup, not the ratepayer. I support enforceable federal drinking water limits, stopping the chemicals at the source, and money for utilities, especially small rural ones, to install treatment they can’t afford on their own. Businesses that follow the rules deserve clear standards and reasonable timelines, and I’ll work with them on that. But water safety isn’t a negotiation. You shouldn’t have to read a utility report to find out if your kid’s bathwater is okay. If a company made the mess and knew about it, it should be the one cleaning it up.
The building and placement of data centers have become a big issue, particularly in many rural communities. What should be the federal government’s role, if any, in how these are developed?
Washington should set the ground rules, and communities should get the final say. These facilities use huge amounts of power and water, and local ratepayers often cover the cost of the grid upgrades while the benefits go somewhere else. I don’t want NC-10 turning into a data center hotspot, and I’ll push for a moratorium until real protections exist. Federally, I’d require public reporting on energy and water use, keep residential customers from paying for upgrades these companies need, and tie any subsidies to community consent. No tax breaks for a project the neighbors don’t want. If it’s such a great deal, it should survive a public hearing.
Is there anything else you’d like our readers to know?
I’m a working class candidate who’s funded by regular people, not big donors. I’m running because I’ve spent 15 years watching patients get hurt by decisions made in Washington. I don’t have all the answers, but I’ll listen first and tell you plainly where I stand, even when you won’t like it. I want to represent everyone in this district, including the many of you who don’t feel at home in either party. If I’m wrong about something, tell me. You can find me at ab4nc.com.
Republish our articles for free, online or in print, under a Creative Commons license.
